One country versus its neighbor
Neighboring countries with similar cultures and religions have wildly different shares of people who consent. In some, almost everyone agrees; in others, only a few percent do. Surveys show that people have roughly the same attitude toward the idea itself.
The difference is in how the choice is set up. Where you are considered to have consented unless you say otherwise, few people refuse. Where you have to state your consent yourself, few people agree. In both cases, the vast majority simply does nothing.
A default is not an empty space. It is a ready-made choice set by whoever designed the form.
You can see this in your own life. Think about how many settings on your phone you changed yourself and how many stayed as they were out of the box. The difference between people is small here: almost everyone leaves almost everything as it is.
Why a checkbox is so powerful
There are several reasons, and they are all boring. Changing a setting takes effort: you have to find the form, figure it out and sign it. Plus, a default feels like a recommendation: if it is set up this way, it is probably customary and right.
There is a third reason, the most important one here. The decision is unpleasant because it concerns your own death, so you want to put it off. A postponed decision automatically becomes whatever is set by default.
The same effect works everywhere there is a form. Pension-plan contributions, newsletter subscriptions, consent to data processing, automatic renewal: in every case, the share of people choosing the default option turns out to be overwhelming.
An important caveat
A high share of people consenting does not mean the same difference in the number of transplants. Other factors then come into play: how the system is organized, the number of suitable donors and conversations with relatives, who are asked in many countries anyway. The default decides the first step, not the whole journey.
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Sources
- Comparison of consent rates in countries with different default arrangements: Eric Johnson and Daniel Goldstein, Science, 2003. The link between these rates and the actual number of transplants is weaker and depends on how the system is organized