Beyond the ticked box: organ donation decision-making under different registration systems

Objective To explore how people experience organ donation decision-making under the conditions of an opt-in, opt-out or no-objection registration system. Design A between-subjects experimental 3 x 2 design (registration system x preselection). Participants (N = 1312) were presented with a description of one of the three registration systems and went through a mock donor registration process. In half of the conditions, the default option of the system was visualized by a ticked box. After, participants answered questions about their perceived autonomy and perceived effective decision-making. Main outcome measurements Perceived autonomy, perceived decision effectiveness and registration choice. Results The preselected box did not impact any of the outcomes. Participants had higher perceived autonomy under the conditions of an opt-in system. There were no differences in effective decision-making across conditions. Registration choices did differ across conditions and educational levels. In the opt-in system, participants more often made an active decision. Lower-educated participants were more likely to choose to do nothing, while higher-educated people more often made an active decision, especially in the no-objection system. Conclusion Where the opt-out system potentially leads to the highest number of donors, the opt-in system seems better in terms of preserving people's autonomy and motivating people to make an active decision.