A minor question here, I wanted to create some political hot-topic debate to have running in the background of a near-future USA. I would like to imagine world that is seriously debating a policy change for deceased organ donors to switch to an opt-out policy rather than the current opt-in policy.

To give context right now after one dies their surviving organs can potentially be donated to others suffering from organ failure. Some countries, like the United States, have opt-in policies; where one's organs are donated only if they sign up to be a donor, in the USA this is usually a box you check when you get a driver's license, though there are other ways to do it. In some other countries the policy is an opt-out one, in which you are presumed to be an organ donor after you pass away unless you explicitly refuse to be.

Very roughly speaking slightly less than 1/3 opt-in or opt-out in respective countries; with a general tendency of more opting-in then opting-out. This meaning that a bit more than 1/3 of individuals go with the 'default option', either donating or not donating depending on rather their country uses opt-in or opt-out policies, due to lack of effort to to express their opinion either way; though this seems to vary drastically between countries. The USA has 45% of its citizens opting-in as donors, though this higher number for America is because some states force citizens to make a choice, one way or another, rather than defaulting them to not donating if they don't explicitly opt-in; Alaska has opt-in rates of over 80%.

Thus, in theory, if the USA switched to an opt-out policy it would gain another 20-30% of its citizens as organ donors, those individuals that did not opt-in previously but also don't bother to opt-out with the new policy

Let's say that changing the US to use an opt-out policy suddenly came to the forefront of politics. Say a recently elected president, or maybe speaker of the house or some other important political figure, decides this was important to them personally and starts a campaign to bring it up in public speeches; making a big deal about people dying due to lack of organs and all the lives saved with the policy and how anyone who doesn't want to be a donor can always opt out so no one is being forced into anything yada yada. Basically, he draws media attention to the topic and keeps it there long enough to start up a debate, due to his already being an important political figure.

The politician writes up a draft bill to support the change. The bill is pretty standard. It stresses funding a number of methods to opt-out being available (at MVA with driver license, any hospital, online, etc etc whatever makes sense). Presume the law explicitly says that government money (federal or state?) should go to hospitals to cover the expense of harvesting organs so that the family isn't charged for it. He passes it to the appropriate individuals (I assume house of representatives, but I don't know where HSRA and state laws come into play here). Debate over rather or not to pass the bill, or how to modify the bill, comes up.

What sort of debate and responses would be discussed? I know some of the obvious debate points

  • lives saved from extra organs donated
  • rather the law 'forces' people to donate by requiring them to opt-out, one side saying opt out is absurdly easy and so anyone that cares would do it so no one is harmed; the other side saying it's unfair to expect someone to have to opt-out to avoid donating
  • debate over costs. One side would argue that the government has to pay more to cover all the extra organs being harvested and transferred and supporting the implantation, the other side arguing that having few people with organ failure means lower medical expenses for treatments like dialysis and thus saving of money.
  • Debate over federal vs state rights to regulate such policies (not sure how much here, not sure where the current rights for this are divided)
  • Possibly some attempt to add riders to modify the specifics for how an opt-out would work; possible by adding ways to make it easier for family of deceased to override the donation presumption?
  • Possibly an argument for deceased who donate an organ to be payed for it, or a claim that a lack of payment is a theft of property?

However, to write the debate I want to get a better feel for how such a debate would progress. The first obvious question would be which party is likely to support the bill and which party is likely to oppose the bill (I have my guesses, but not convinced since I could see arguments otherwise). Other than that I'm trying to envision other arguments that would be used for or against. In fact not just logical valid arguments, what rhetoric, exaggerations, and propaganda will come up as well? After all most political debates seem to be at least 50% rhetoric rather than valid debate, so I want to capture the reality.

How much of a lively debate could the topic really make?


closed as too broad by James, Samuel, AndreiROM, JDługosz, Frostfyre Dec 11 '15 at 1:07

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    $\begingroup$ I suggest asking for something like "What is the most convincing argument against switching to an opt-out system?". Otherwise it's a bit too broad. $\endgroup$ – Samuel Dec 10 '15 at 22:45

"How much of a lively debate could the topic really make?"

I hate to pour cold water on a scenario into which you have obviously put considerable work, but judging from the example of Wales, not much at all. Wales cooperatively / apathetically (circle whichever adjective you prefer) moved from an opt-in to an opt-out system for organ donation on 1 December 2015. The rest of the UK continues to have an opt-in system. There is more information on the move in this article in the Daily Telegraph. It appears some bishops put up a few mild objections.

"Other than that I'm trying to envision other arguments that would be used for or against. In fact not just logical valid arguments, what rhetoric, exaggerations, and propaganda will come up as well?"

I've got one that would set the debate on fire.

Weeks before the vote there is a proven case of someone suffering locked-in syndrome, combined with other symptoms that mimic the appearance of brain death, who comes within a whisker of having her organs removed. Imagine she actually hears the doctors discussing the removal of her organs while she desperately tries to break through her paralysis to signal that she is alive and conscious. Somehow she manages to flicker an eyelid and later makes enough of a recovery to give credible testimony, such as quoting the doctors' exact words, as to how close a thing it was.

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    $\begingroup$ not that much work was put in. I already knew all of this, which is why I used it as an example. I'm a kidney donor myself, learned everything while I was researching rather or not to donate ;) I like your example, it definitely would cause lots of new chaos, probably get the bill failed. I don't believe that there is all that credible threat of an actual accidental harvesting knowing the pre havest process, but I can still see a discussion of a harvesting prior to someone being proven still alive that could cause just as much chaos. $\endgroup$ – dsollen Dec 10 '15 at 21:48

The key issue is whether ethics should be based on consent or whether you believe in utilitarian where only the effects of your actions matter and consent doesn't.

If you look at other debates in the US where consent is a big deal, there's sex. Feminists push for "Yes means Yes" consent laws. To the extend that you believe in "Yes means Yes" as a general principle it makes sense to oppose organ harvesting without expressed consent.

On the other end of the spectrum you have religious people who care about the sanctity of life. It's possible for a church leader to declare that death as the Bible means the term means that a person can't be reanimated in principle by human intervention and doesn't just mean that the EEG goes to zero.

Practically it's also worth noting that the choice isn't really anymore between opt-out and opt-in. The modern policy is forced choice if you want certain government benefits like getting a drivers license. Forced choice is how Alaska has it's 80% opt-in rate.

Given Christians who oppose stem cell research as immoral it's not that hard to make the against the current way organ donation is done. If a Democratic president would push for organ-donation without explicit consent there a good chance that the resulting rate of people signed up for organ donation is less than it would be with forced choice. The debate has the danger to raise ghosts that everyone who cares for organ donations would rather have sleeping.

A/B testing to optimize sign up rate at forced choice documents is a policy that makes much more sense than organ donation without explicit consent if someone would want to increase the number of available organs.

  • $\begingroup$ Modern policy in the US is not always fixed choice. Each state implements it differently, and some (most?) states still implement the more traditional opt-in policy. You could argue that the more likely debate would be from opt-in to all fixed-choice; but that creates less political turmoil, which is sort of the point here ;) $\endgroup$ – dsollen Dec 10 '15 at 21:53

In the grand scheme of things opt-in versus opt-out may not seem like a topic that would be a big deal, but it could definitely be made into one in the current (and likely near-future) political climate of the United States.

This could be argued to have a net positive gain for society while it also causes the government to restrict freedom of citizens. While I don’t have numbers at the moment to back up the positive societal gain (or dispute it), it stands to reason that an opt-out policy would result in more viable organs available for transplant. On the flip side, the restriction of freedom angle is caused by multiple issues but hinges on a central fact: at the death of an individual, they may have not wanted to have their organs donated but never opted out. This will absolutely cause disputes in which family members are portrayed as being unable to properly carry out the wishes of their deceased loved ones due to government interference.

The solution to the problem above is to ensure that every person is given the opportunity to opt out at the moment that they transition legally from parental control to personal control. In practice, this just isn’t possible to do thoroughly. Most states in the US currently use one’s driver’s license for opt-ins. Identification in general is an oft-cited place to mark your desire to be an organ donor, but as has been seen in multiple other political issues (particularly ID requirements when voting), a non-trivial part of the population is not in a position to get an ID or simply doesn’t care to do it. Any fool-proof solution you attempt to implement will probably be an expensive logistical nightmare and will still have people falling through the cracks. Some, if not many conservatives and others who are against expanding the government’s role in people’s daily lives will likely find this entire concept to be government overreach. Liberals would probably be more in favor of it, though may also seek changes to make it easier for low-income people to opt-out without needing to pay for an ID.

I won’t go into patterns for rhetoric on either side, but I’m sure that even a brief look at current pre-election rhetoric in the media today will give you more than enough material to twist into this scenario.


You could get something like that portrayed in Larry Niven's Jigsaw Man.

In the future, criminals convicted of capital offenses are forced to donate all of their organs to medicine, so that their body parts can be used to save lives and thus repay society for their crimes. However, high demand for organs has inspired lawmakers to lower the bar for execution further and further over time.

In it, the protagonist is

sentenced to death for repeated traffic violations.


  • $\begingroup$ not sure it's a fair comparison. The idea is that everyone is equally an organ donor in the opt-out, so there is no one group that is more organ donor and thus no real benefit to tactics like this. Though I suppose some argument that some group is disproportionately 'tricked' into donating an organ in the opt-out system would come up. which depends on which political party supports it though $\endgroup$ – dsollen Dec 10 '15 at 20:46
  • $\begingroup$ as a side note, executed prisoners are horrible sources of organs. Anyone that spends any length in prison is not allowed to donate blood because of the increased risk of contracting HIV, and anyone likely to be convicted of capital offenses is likely to have a higher risk nature that makes them more likely to have STDs. I don't think they would want the organ's of a killed conflict. And of course if killed by lethal injection a number of his organs are destroyed anyways. $\endgroup$ – dsollen Dec 10 '15 at 20:49
  • $\begingroup$ That's if we use the current penal system. In Larry Niven's vision of the future, the situation is cleaned up quite a bit from what we see now. $\endgroup$ – Jim2B Dec 11 '15 at 0:45

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