Liberty or Life?: Increasing American Organ Donation Registration

Authored by: Evelyn Caputo

Art by: Kendall Eddington

Since the first organ transplantation in December 1954, the scientific community has experienced numerous breakthroughs which now enable healthcare professionals to transplant approximately 19 different organs and tissues into the human body [1][2]. According to Mayo Clinic, one organ donor can save up to eight lives and improve the lives of 75 people through tissue and cornea donation [3]. This statistic demonstrates the impact that just one organ donor can have on others. With over 100,000 people on the national organ transplant list, organ donation is critical to the transplant process and saves hundreds of thousands of lives each year [3]. Despite this, donation rates remain low, with about 90% of Americans in support of organ donation, yet only about 60% registered to donate their organs [4]. Low registration rates are likely due to factors including religious concerns, cultural beliefs, and mistrust in the healthcare system. 

For instance, certain cultural or religious groups, including Native Americans, Roma Gypsies, Confucians, Shintoists, and some Orthodox rabbis, tend to oppose organ transplantation from a deceased donor [5]. Additionally, some believe the human body is sacred and should not be disturbed immediately after death [5]. Nevertheless, a high percentage of religions actually support both organ donation and transplantation. If this is the case, then it is likely that low registration rates result primarily from the fear that people will receive lower-quality medical care so that their organs can be used for someone else [3]. These barriers to organ donation registration raise questions about how the process should be structured to maximize the number of willing organ donors while still respecting people’s beliefs and concerns.

In order to respect patient concerns, two systems of organ donor registration are globally considered the most ethical: the opt-in and opt-out models. An opt-in approach requires people to state whether or not they would like to be a deceased organ donor [6]. In this system, a person is not automatically assumed to be a donor, while in an opt-out system, consent to donate organs after death is presumed unless otherwise stated [6]. While the United States uses an opt-in model, Stanford researchers found in 2012 that the donor registration rate for an opt-in country was 45%, compared to 63% for an opt-out country [7]. Increasing the number of organ donors would normalize the practice, leading to more trust in the system and healthcare professionals as a whole. Therefore, an opt-out model is something that the United States could consider adopting in order to improve registration rates, which then helps more people. 

That being said, each model introduces an ethical dilemma. The opt-out model favors societal gain, reflecting utilitarian values, while the opt-in model favors individual rights, supporting libertarianism. While people’s individual freedoms must be taken into consideration, it must also be acknowledged that in the United States, an estimated 17 people die every day waiting for an organ transplant, with a new person being added to the transplant list every 9 minutes [1]. This fact raises the question of what Americans value more – liberty or life itself?

Due to the unethical nature of forced donation and the low donor registration rates in the United States, other avenues may be explored. For example, the creation of artificial organs through 3D printing or stem cell regeneration has become extremely prevalent, yet the ethicality of these methods must also be considered. People may be hesitant to explore these new technologies because most are in the experimental stage. Additionally, the use of artificial or stem cell-regenerated organs requires DNA sequencing and could lead to illegal distribution of patients’ genetic data [8]. 

Ultimately, because organ donation is not widely accepted and the ethicality of certain models is unclear, we must weigh the available options: either the United States should adopt an opt-out model of organ donor registration or further examine the ethical implications of 3D printed and stem cell-regenerated organs. 

References

1. Realizing the promise of equity in the organ transplantation system. (2022). https://doi.org/10.17226/26364

2. Cleveland Clinic. (2025, May 19). Organ Donation and Transplantation. Retrieved October 13, 2025, from https://my.clevelandclinic.org/health/treatments/11750-organ-donation-and-transplantation

3. Mayo Clinic. (2023, May 04). Organ donation: Don't let these myths confuse you. Retrieved October 13, 2025, from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/organ-donation/art-20047529

4. DonorAlliance: Organ & Tissue Donation. (2025, June 16). How Many People are Organ Donors? Retrieved October 13, 2025, from https://www.donoralliance.org/newsroom/donation-essentials/how-many-people-are-organ-donors/

5. Bruzzone, P. (2008). Religious aspects of organ transplantation. Transplantation Proceedings, 40(4), 1064-1067. https://doi.org/10.1016/j.transproceed.2008.03.049

6. Etheredge, H. R. (2021). Assessing global organ donation policies: Opt-In vs opt-out. Risk Management and Healthcare Policy, Volume 14, 1985-1998. https://doi.org/10.2147/rmhp.s270234

7. Davidai, S., Gilovich, T., & Ross, L. D. (2012). The meaning of default options for potential organ donors. Proceedings of the National Academy of Sciences, 109(38), 15201-15205. https://doi.org/10.1073/pnas.1211695109

8. Ricci, G., Gibelli, F., & Sirignano, A. (2023). Three-Dimensional bioprinting of human organs and tissues: Bioethical and medico-legal implications examined through a scoping review. Bioengineering, 10(9), 1052. https://doi.org/10.3390/bioengineering10091052