Two minutes. One documented yes.
Register →The argument
Most Americans support organ donation. Far fewer are registered. That gap isn't apathy. It's created by how, when, and whether people are ever actually asked.
Three systems
The U.S. default
You are presumed to be a non-donor unless you actively register. The willing majority is never captured, because most people are simply never asked at the right moment.
“Presumed consent”
Everyone is presumed a donor unless they opt out. But opt-out countries don't automatically get more transplants — family authorization, OPO coordination, and clinical capacity are the real rate-limiters. Spain, the usual example, owes its results to its coordination infrastructure, not the default alone.
What OAI advocates for
Every adult is required to answer the question — yes or no. Nobody is presumed into anything. It respects autonomy, captures the willing majority, and produces a documented decision families can't override in the ambiguous moment.
Opt-in leaves a gap between the 90% who support donation and the 60% who are signed up. Mandated choice is designed to close it — by asking everyone, once, and recording the answer.
Be clear about what opt-out does and doesn't do.Presumed consent is not a silver bullet. Opt-out countries don't automatically get more transplants; family authorization, OPO coordination, and clinical capacity are the real rate-limiters.
The affirmative case for mandated choice is that it respects autonomy (nobody is presumed into anything) while still capturing the willing majority and producing a documenteddecision families can't override in the ambiguous moment.
The honest objection: mandated choice can produce more recorded Nos than a system that simply never asks. We think a recorded, respected decision, in either direction, is better than a nation of defaults. But it is a real trade-off, and we won't pretend otherwise.
Intellectual honesty
Saying this plainly is not a weakness. It's the difference between advocacy and evidence — and it's the standard we hold our own work to.