Deceased by default: Consent systems and organ-patient mortality

Bart H. H. Golsteyn, Annelore M. C. Verhagen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Previous research shows that countries with opt-out consent systems for organ donation conduct significantly more deceased-donor organ transplantations than those with opt-in systems. This paper investigates whether the higher transplantation rates in opt-out systems translate into equally lower death rates among organ patients registered on a waiting list (i.e., organ-patient mortality rates). We show that the difference between consent systems regarding kidney- and liver-patient mortality rates is significantly smaller than the difference in deceased-donor transplantation rates. This is likely due to different incentives between the consent systems. We find empirical evidence that opt-out systems reduce incentives for living donations, which explains our findings for kidneys. The results imply that focusing on deceased-donor transplantation rates alone paints an incomplete picture of opt-out systems' benefits, and that there are important differences between organs in this respect.

Original languageEnglish
Article number0247719
Number of pages15
Issue number3
Publication statusPublished - 17 Mar 2021

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