TIL that in Singapore, people who opt-out of donating their organs are put on a lower priority to receive an organ transplant than those who did not opt-out.

In the US, at least in a lot of the US, it gets asked when you sign up for a driver's license, which is something like 85% of all adults. I don't think it typically gets asked again when you renew, but I could be misremembering.

The proportion of organ donors would probably be way higher if it were opt-out though. There are a lot of people who don't really care either way, but decide not to opt in (or just ignore that part of the form).

Because the default is opting out and donors are seen as "heroic" in some sense, you get a lot of people saying "I don't feel like I need to be a hero", even though it costs them nothing. If it were the other way around, if it were phrased not as "will you go above and beyond the norm and opt in?", but rather "will you be more selfish than the norm and opt out?", I think you'd probably see a lot more donors. You want the decision to opt out to seem exceptional, not for the decision to opt in to seem exceptionally altruistic.

It also feeds into myths about how doctor's might not try to save you in an accident if you're a donor.

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