Mandated choice. A plan to increase public commitment to organ donation

To estimate the impact of mandated choice--a system that requires competent adults to decide prospectively whether or not they wish to be organ donors when they die--on public commitment to organ donation; and to explore who is best suited to provide consent--the family or the individual?

A national, random-digit telephone survey conducted by the Gallup Organization in July 1993.

A representative sample (n = 1002) of adults (aged 18 years and older) living in homes with telephones in the continental United States.

Although the majority of respondents had given at least some thought to organ donation, only 25% had carefully considered this issue. Overall, 30% had decided to donate, but 58% were undecided and only 38% had made their wishes known to a family member. Yet the vast majority (82%) believes that the best way to obtain consent is for each adult to decide for himself or herself, rather than leaving this decision for the family. Under mandated choice, which is designed to encourage such self-determination, 63% would sign up to donate, 24% would not, and 13% were unsure.

Only a small fraction of the US public is currently committed to organ donation and relatively few people have carefully considered and communicated their wishes regarding this important issue. Therefore, the difficult question of consent is often left for the family. Yet most people believe that ideally all adults should answer this question for themselves, in contrast to our present family-oriented approach, but consistent with the design of mandated choice. If mandated choice became law, it appears that most adults would sign up to donate, thereby increasing the pool of desperately needed committed donors.