CA Organ Donor Law

California has a new law creating a live donor registry for kidney transplants and requiring California drivers to say yay or nay on whether they want to be organ donors when they renew their drivers' licenses.  The law was passed with the prodding of Steve Jobs who last year had a liver transplant.

The live donor registry is very good. The required declaration is mixed but I hope it works.  I see it as follows.  The benefit is that if a potential donor has said yes to organ donation then next of kin almost always agree to their wishes so if more people positively affirm that is good.  The cost, however, is that now "no" really means "no" and next of kin will presumably agree to that as well.  Previously, next of kin might have said yes to non-signatories.  Let's use some back of the envelope figures:

100 potential donors
20 signed organ donor cards
80 do not sign but, among these, half the families say yes so 40.

Total: 60 donors.

So with declaration you need more than 60 to agree to be organ donors, i.e. a huge increase in those saying yes.  It could happen if what people say on surveys about supporting organ donation is true but I would have been much happier with even a small incentive to sign.  How about a free iPhone for signatories?  Or at least some more minutes!

See here for more on incentives and organ donation.

Addendum: Nudge blog has some helpful comment–the law appears to be closer to mandated ask than mandated choice.


Here is a Thaler blub on this "Richard Thaler writes about opt-in vs. opt-out vs. mandated choice organ donation policies.... Illinois follows a mandated choice policy.

Here is how it works: When you go to renew your driver’s license and update your photograph, you are required to answer this question: “Do you wish to be an organ donor?” The state now has a 60 percent donor signup rate, according to Donate Life Illinois, a coalition of agencies. That is much higher than the national rate of 38 percent reported by Donate Life America

The Illinois system has another advantage. There can be legal conflicts over whether registering intent is enough to qualify you as an organ donor or whether a doctor must still ask your family’s permission. In France, for example, although there is technically a presumed-consent law, in practice doctors still seek relatives’ approval. In Illinois, the First-Person Consent Law, which created this system, makes one’s wishes to be a donor legally binding. Thus, mandated choice may achieve a higher rate of donations than presumed consent, and avoid upsetting those who object to presumed consent for whatever reasons. This is a winning combination."

This is a classic default-choice effect. Most questions are phrased either positively or negatively - whether you want to be an organ donor, or whether you want to opt out of being an organ donor. They lead to participation rates of 5-10% and 80-100%, respectively. Furthermore, there are end-of-life complications because doctors want to harvest organs as close to end of death as possible, but it's always a socially awkward situation to come in to the family right after their loved one has died, to ask them if they want to donate their loved ones' organs. It almost never leads to a donation. Furthermore, even people who have stated that they are organ donors often have that decision rescinded post-death by their family. Thus, your back-of-the-envelope calculations are at least an order of magnitude off.

Keen young doctors, or perhaps greedy old ones, will bump people off to get their organs. Unless you believe that incentives don't matter.

I refuse to give away for free what I am forbidden to sell. I am proud to say that I am most definitely not an organ donor.


The transplant physicians have no interaction with the patient before the decision is made regarding transplants. The physicians that care for the patients also have no hand in the transplant process. There is no incentive for a physician who is caring for a patient to kill them for organs.

I still don't see the Alex's argument in the back-of-the-envelope calculations.....If you estimate that 50% of the families would have said "yes" in scenario-1 then why is it hard to believe that 60% of the drivers might themselves say yes in scenario-2?

To me it definitely looks like a positive development; I can't see why Alex is half-hearted about it?.....

Wow. Jimbino is the definition of evil.

Incentives are important, which I why I don't understand why we don't yet have a system in place to reward donors in-kind. You agree to donate, you can receive organ donations. You don't agree to donate, you can't get organs unless and until all the potential donors have received what they need. We can have some sort of system build in where you can't game the system by switching at the last minute by saying you must have been an irrevocably declared donor for at least five years (with adjustments that don't cause that to penalize minors or recent adults).

If you place a value on donated organs, and they go to a charity, does anyone, including the estate, get a charitable deduction.

My wife and I both fear that doctors might treat us differently if they know they can take the organs. So, we're not listed as donors, but we each know that we can donate the organs once we're certain the other is dead.

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I would agree to be an organ donor, if my family received the market value for the organs I am donating.

People don't think it is ethical for someone to get paid for organs... yet at the same time it is ethical to pay the doctors, the nurses, the drug suppliers, etc... Everyone gets paid, except for the family who just lost a love one and who may very well be facing financial hardships.

Saying that if you dont offer to donate means you will not be first in the queue as some are suggestion is just not workable. I cannot see a doctor allowing someone to die just because they have not signed a donor register and so giving an available organ to someone else who, perhaps, is not as seriously ill and would not die if they had to wait. Not only that, but who are we to play God to say who lives or dies? More education is required. People do not sign up because they are scared they will be allowed to die so someone else can be saved. Here in the UK even if someone has signed the donor register, the next of kin are always asked if they will allow the donation. I believe 1 in 4 potential donations are blocked because next of kin refuse. It is not only essential we sign the donor register but that we talk to our next of kin and make it clear to them what our wishes are and they need to support those wishes.

Incentives could be used. If someone signs the donor register and their organs are used then funeral expenses could be paid by government. They can amount to quite a lot. Other incentives are also possible. I dont agree though with pushing people to the top of the list if they do agree or down the list if they don't. Also what is stopping someone from signing the register when they know they have a disease that would require transplant in the future. Waiting to have the transplant then taking themselves off the register? I know some people that would do that.

Schools can help a lot. If our kids are taught about illnesses that require transplants and the importance of not being a heavy drinker, not smoking, not eating unhealthy food big time, and they are also taught about the importance of organ donation and signing the register to help save someone. People waiting for transplants could talk to school kids to show them the awful existence they have while waiting. As the kids grow up they will be more inclined to sign that donor register, or even be a living donor. It could even reduce the number of people wanting donations as they have been taught how to keep healthy to avoid those illnesses. Our kids are tomorrows future and tomorrows donors so fully educate them now.

There is no easy quick fix to getting people to sign the donor register or even being a living donor but I strongly feel it is not a good idea to hold a gun to anyone's head (figuratively, of course!) and say sign or you go to bottom of the waiting list. Some people are truly scared of signing the register because they do believe that not every effor would be used to save them. That is a big fear that needs to be addressed. Especially as now as it is not just brain dead people whose organs can be used.

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