Beyond the ticked box: organ donation decision-making under different registration systems

ObjectiveTo explore how people experience organ donation decision-making under the conditions of an opt-in, opt-out or no-objection registration system.DesignA between-subjects experimental 3x2 design (registration system x preselection). Participants (N=1312) were presented with a description of one of the three registration systems and went through a mock donor registration process. In half of the conditions, the default option of the system was visualized by a ticked box. After, participants answered questions about their perceived autonomy and perceived effective decision-making.Main outcome measurementsPerceived autonomy, perceived decision effectiveness and registration choice.ResultsThe preselected box did not impact any of the outcomes. Participants had higher perceived autonomy under the conditions of an opt-in system. There were no differences in effective decision-making across conditions. Registration choices did differ across conditions and educational levels. In the opt-in system, participants more often made an active decision. Lower-educated participants were more likely to choose to do nothing, while higher-educated people more often made an active decision, especially in the no-objection system.ConclusionWhere the opt-out system potentially leads to the highest number of donors, the opt-in system seems better in terms of preserving people’s autonomy and motivating people to make an active decision.