Does default organ donation registration compromise autonomous choice? Public responses to a new donor registration system

• Published in: Health policy (Amsterdam) 2022-09, Vol.126 (9), p.899-905
• Main Authors: Wachner, Jonas, Adriaanse, Marieke, Hoven, Mariette van den, de Ridder, Denise
• Format: Article
• Language: English
• Subjects: Autonomy; Default effect; Field experiment; Nudging; Organ donation
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2022.07.002

•Default organ donation registration generally does not compromise personal autonomy.•People ignoring an invitation for default registration report lower personal autonomy.•Default nudges should distinguish between passive and active response formats. Defaults have been shown to increase the number of organ donor registrations but it is unclear whether they violate personal autonomy of the people being registered. The implementation of a new Donor Act in the Netherlands, providing people with the opportunity for active registration before being defaulted, allowed for examining to what extent default registration affects personal autonomy and associated concepts. In an online survey among a representative sample (N = 1259), four groups were compared regarding autonomy, decision-making competence, decision satisfaction, and being pressured to register as a donor: people (1) who had registered their status prior to the Donor Act, (2) who had not yet received an invitation for default registration, (3) who had received an invitation and then registered their choice, and (4) who had received an invitation but took no action and were defaulted into donor registration. We found that among the three groups who were the target population of the new arrangement, people who registered their status reported relatively high levels of autonomy and related concepts. However, people who were invited to register but passed the opportunity to respond reported lower scores on these outcomes. We conclude that default organ donation registration may bear negative consequences for a minority of people who feel unable to take action after having been invited to make a choice for registration.