Nudging to donate organs: do what you like or like what we do?

Med Health Care Philos. 2021 Sep;24(3):329-340. doi: 10.1007/s11019-021-10007-6. Epub 2021 Mar 17.


An effective method to increase the number of potential cadaveric organ donors is to make people donors by default with the option to opt out. This non-coercive public policy tool to influence people's choices is often justified on the basis of the as-judged-by-themselves principle: people are nudged into choosing what they themselves truly want. We review three often hypothesized reasons for why defaults work and argue that the as-judged-by-themselves principle may hold only in two of these cases. We specify further conditions for when the principle can hold in these cases and show that whether those conditions are met is often unclear. We recommend ways to expand nationwide surveys to identify the actual reasons for why defaults work and discuss mandated choice policy as a viable solution to many arising conundrums.

Keywords: As judged by themselves; Automatic enrolment; Default rule nudge; Mandated active choice; Organ donation.

Publication types

  • Review

MeSH terms

  • Humans
  • Public Policy
  • Surveys and Questionnaires
  • Tissue Donors
  • Tissue and Organ Procurement*