The Illusion of Generosity: Comparing the Effectiveness of Opt-In and Opt-Out Organ Donation Systems in the United States and Belgium

Abstract

Well-intentioned illusions remain shallow, no matter how many oases appear promised in the distance. After the first successful heart transplantation occurred in 1967, opt-in and opt-out consent legislation erupted with the promise to increase donations. Despite the revolution of policies in the United States and Belgium, the resulting systems have failed to meet the demand of organ shortages. Examining consent legislation alone will not quench the ever-rising cries for scarce resources; presuming generosity will increase if governments change how people can donate ignores the messy business of grief, doubt, and the very human instinct to hold on. The law may assume the body’s availability, but the heart—both literal and metaphorical—remains stubbornly unclaimed.