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In the United States, the need for organ transplants increases every day. Despite the high demand, people are not required to be registered organ donors. An opt-in system allows a licensed citizen to join the donor list, or remain off of it. An opt-out system automatically registers citizens as organ donors, however they are able to remove themselves if desired. A no objection system creates the option to leave the decision to the next of kin after death. The United States currently uses an opt-in system. With only 54% of eligible donors registered, almost 120,000 people are still waiting for a life-saving transplant (Penn Medicine 2019). This discrepancy is not unique to the U.S. In fact, a lack of organ donations exists worldwide. A team of researchers from the Department of Health Promotion came together to combat this issue. Their goal was to examine how different donor registration systems affect the decision-making of eligible donors. The real question is, can a simple change in nomenclature solve this health crisis, or is there a deeper cause to unpack?

Esther Steenaart, Rik Crutzen, and Nanne K. de Vries from Maastricht, Netherlands conducted a study in 2020 on 1,290 Dutch participants, over the age of eighteen. Each person was assigned to one of six conditions. For each of the three registration systems – opt-in, opt-out, and no objection – there were two groups. One group would have the default option visibly ticked on their sheet while the other group would not. Each participant was briefed on the questionnaire presented to them, and then asked to choose one of three options: Do nothing, actively register as a donor, or actively register as a non-donor. The ‘I do nothing’ means the participant will go with the default option preselected ahead of the trial. Other questions on the form measured autonomy satisfaction/frustration (ASF), and effective decision-making (EDM) (Steenaart E. et al. 2020).

There was a correlation found between he different registration systems’ respective results, however the researchers did not consider these findings to be significant. The visible default option did not lead to a difference in the participants’ decisions compared to having no visible default option. In fact, this aspect of the experiment was disregarded in result analysis. The true differences were found between registration choices under different systems. Almost 60% of participants actively registered yes under the opt-in system, the highest of any of the systems. The no-objection system resulted in the most active no responses at 25%. Researchers believe these results are due to feelings of autonomy. ASF was reported to be higher among the opt-in participants compared to the opt-out and no objection participants (Steenaart E. et al. 2020).

One major limitation that the authors admitted to was the fact that all decisions made by the participants were hypotheticals. They were not actually signing up to be organ donors or agreeing to let their spouse’s organs be harvested after death. 76% of participants actively registered yes or no under the opt-in system during the study; however, in the Netherlands, only 42% of people actively register under the same system. (Steenaart E. et al. 2020). Oftentimes it is much easier to say you will do something until you are actually put in that situation. Another flaw is how much information participants were forced to read before making their decision. In real life, you are not mandated to read about organ donor registration. Without all of the information, real citizens may not respond the same way the participants in this study did. In the future, scientists should try to mirror a real-life scenario. Although it will never be perfect, the test subjects should be in as close to a regular environment as possible with the same information available to them.

The Dutch experiment shows that a change in organ donor registration system will not be enough to close the disparity between available organs, and needed transplants (Steenaart E. et al. 2020). Why do people actively choose not to be a donor? David Shaw from Intensive Care Medicine offers some insight to this matter. Organs must be removed soon after death in order to be transplantable, which many people feel will be too hard for grieving family members to handle. Others have religious or cultural ideals that do not align with organ donation. (Shaw D. 2015). Researchers from the University of Illinois researched these reason further, finding that many mature adults believe their organs would not be suitable. (Quick B. et al. 2016). Just one misconception could be the difference between a saved life, and a lost life. Continuing to conduct similar experiments to determine peoples’ reasons not to donate, and how to change their minds is an important next step for researchers.

Some might ask, why should a Dutch study have any implications in the United States? 120,000 Americans are waiting for a life-saving organ donation (Penn Medicine 2019). This research not only gives insight into how the U.S. can fight its crisis, but also sets a foundation for similar research to be conducted there. These 120,000 Americans need help from their fellow citizens. These fellow citizens need help realizing the role they can play in saving peoples’ lives. Just one registered organ donor can save the lives of eight people. (American Transplant Foundation 2019). Eight children, mothers, fathers, and even neighbors can regain their lives with just one decision.

The question remains, what does it take to increase the number of registered organ donors? It seems changing the system may kick-start the movement, but there is more to be done. David Shaw only starts the conversation about why some choose not to be donors. Research needs to be done to understand these people’s reasons, and possible ways to change their view on organ donation. One lost life has the potential of saving eight people; however, without registration, nothing can be done. Researchers and American citizens need to act now to start taking names off the transplant waiting lift, instead of adding more to it. There is no time to waste.




American Transplant Foundation. 2019. Facts: did you know? Facts and Myths. [accessed 2020 Aug 31];

Penn Medicine. 2019. 5 quick facts about organ donation. Organ Donation. [accessed 2020 Aug 22];

Shaw D. 2015. Organ donation is the right decision: a delicate truth. Intensive Care Med. [accessed 2020 Aug 31]; 41(1):1487-1488. doi:10.1007/s00134-015-3891-1.

Steenaart E, Crutzen R, de Vries N. 2020 Jun 2. Beyond the ticked box: organ donation decision-making under different registration systems. Psychology & Health. [accessed 2020 Aug 27]; 34(11):1-30. doi:10.31234/

Quick B., Reynolds T., Fico A., Feeley T. 2016 Jul 26. An investigation into mature adults’ attitudinal reluctance to register as organ donors. Clinical Transplantation. [accessed 2020 Sep 14]; 30(10):1250-1257. doi:10.1111/ctr.12815



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