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.