To avoid the default, some writers would encourage people to decide about donation in a way others will know, for instance by paying them (De Wispelaere and Stirton 2010) and others suggest mandating choice by, for instance, withholding driving licenses from those who do not choose.
When making ethical decisions, it's important to recognize that your way isn't the only way, and that even mandated choices will have consequences that you must deal with.
Three defaults in organ donation systems are compared: mandated choice, presumed consent and explicit consent.
Fortunately, there is another possibility, called "mandated choice," under which people must indicate their preference.
Illinois has adopted my favorite solution to this problem, and it's a neat little compromise which is called mandated choice.
Thus, mandated choice may achieve a higher rate of donations than presumed consent, and avoid upsetting those who object to presumed consent for whatever reasons.
Hypothetical choices from a national survey of 2069 respondents in May 2011 in the Netherlands – a country with an explicit consent system – suggests that mandated choice and presumed consent are more effective at generating registered donors than explicit consent.
They say the best system is a two-way register, or mandated choice system, whereby people explicitly state either their wish to donate or their objection to doing so.
The researchers found that regardless of where the participants came from they perceived the donor's underlying preference to donate as stronger under default opt-in and mandated choice systems (where participants have to express a preference) compared with default opt-out and mandatory donor systems.
While the underlying idea is often correct and families do default to 'no' when uncertain about the deceased's wishes, neither mandated choice nor its cousins seems likely to increase retrieval rates by much.
Wilcoxon signed ranks test: mandated choice vs. donor-only informed consent, p <0.001; mandated choice vs. donor-or-surrogate informed consent, p <0.001; mandated choice vs. presumed informed consent, p <0.001.
