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What’s wrong with saving lives?

5 min read

“Would you like to receive e-mail offers for coupons and special promotions?”

No, I would not. Click.

“Would you like to receive e-mail offers from our partners?”

Nope. Click.

The small squares, which until a moment ago had check marks in them, were now blank. With two clicks of the mouse – minimal exertion – I had opted out.

Like most websites, it had assumed I’d want to get coupons or notes about clearance sales via e-mail. I’m sure some people do, but I don’t. So all I had to do was tell them I didn’t.

I realize that if I had done nothing, e-mails would’ve shown up in my inbox, but I’m not offended that they defaulted my choice to yes. After all, I very simply changed it to no. Simple. Easy. Painless.

It’s a task anyone who has ever registered for a website or bought something online has encountered. Sure, you may be annoyed that your favorite site assumes you want junk mail, but nobody throws a fuss about it. After all, the only thing you have to do is be on the lookout for it and make sure to click the opt out before submitting. Done and done.

But if the assumption isn’t about junk mail, and instead about, say, your willingness to donate your organs – well then, that’s a completely different story. In that scenario, to assume I would say yes is a terrible government plot to harvest my organs.

Oh wait, no it isn’t. But the freakout over organ donation was as intense as it was predictable.

Let me start at the beginning.

A bill proposed last week in Colorado would have changed the default for organ donation from “off” to “on” for the state’s residents. The “presumed consent” is common in Europe and is credited there for dramatically raising organ donation rates.

Now, before you put on your Tea Party tinfoil hat, the bill would not have forced anyone to help others; anyone who didn’t want to be an organ donor could simply and easily opt out.

(No one was going to be forced to be a decent person – organ donation is a wonderful thing. Your organs aren’t doing you any good after you croak, but can sure as hell do something for someone else.)

Under the proposed bill, everything stays the same: you want to donate your organs, you can; you don’t want to donate your organs, you don’t have to. The bill instead makes it easier – and more likely – for would-be donors to actually sign up to be donors.

At its essence, the bill acknowledges that defaults matter a great deal. Whether it’s enrollment in a 401(k) or organ donation program, a large number of people will simply choose the default by lack of action or attention.

The problem is the number of people who are organ donors is a lot lower than those who say they would donate their organs. It’s clear a number of people simply aren’t jumping through the hoops to opt in, which the current system requires in Colorado (and across the nation).

One study in Iowa found 97 percent of respondents said they supported organ donation and sizable majorities said they were willing to donate their own organs. However, of those who said they wanted to donate their organs, only 64 percent had checked the box to actually enroll.

By setting the default at no, the system ensures that organ donation levels will be low because of inertia and human tendencies toward inaction. The need to actively change from no to yes was deterring otherwise willing participants from, well, participating.

The Colorado bill acknowledges the importance of what academics Richard Thaler and Cass Sunstein call “choice architecture,” in their treatise on the subject, “Nudge: Improving Decisions About Health, Wealth and Happiness.”

Thaler and Sunstein argue that there is choice architecture for everything – the placement of options, the presence of options and the choice as to what is the default, etc. And since defaults are ubiquitous and powerful – people have a “strong tendency” to choose defaults, the authors write – we ought to at least acknowledge that you have to choose a default, so we might as well avoid picking the worst one. In that way, you’re not telling anyone what they should or should not do, but helping to nudge them in the most beneficial direction. (You’re realizing that’s the title of the book now, aren’t you?)

Which brings us back to Colorado. People say they want to be organ donors, and society needs more organ donors – the nationwide waiting list was 110,179 as of Jan. 11, according to U.S. Department of Health and Human Services.

The number looks even more onerous when you realize that from January to October 2010, a total of 23,955 transplants were performed from 12,088 donors. In Colorado, 1,968 are awaiting organ transplants. Demand far outstrips supply.

When it comes to the proposed bill, we can pretend that picking a better default amounts to some Orwellian plot to steal your insides or we can be adults about the situation and realize that the current choice of default is literally killing people – and no, changing that default won’t mean the end of the world.

Unsurprisingly, Coloradans went with the former. The backlash was swift and vitriolic. Even though no one’s freedom was undermined – let me repeat: no one had to donate – there were dire warnings about loss of freedom. The raw, emotional aversion to the thought of the government demanding your organs when you die trumped the more logical discussion over what the bill actually proposed.

“There is a lot of misinformation out there, and people are scared and upset. It’s just causing too much fear,” said the bill’s sponsor, Sen. Lucia Guzman, D-Denver, Friday in announcing she was withdrawing the lifesaving bill.

Paranoia wins. Those on the transplant list lose.

If you’d like to point out his defaults, Brandon Szuminsky can be reached at bszuminsky@heraldstandard.com.

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