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Does implementing opt-out solve the organ shortage problem? Evidence from a synthetic control approach

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  • Selina Schulze Spuentrup

    (ifo Institute
    TUD Dresden University of Technology)

Abstract

In light of the persistent shortage of organ donations needed to save precious human lives, several countries have modified their organ donation laws by introducing an opt-out system, making every deceased a potential organ donor unless the person has objected. This study examines the impact of adopting opt-out on organ donation rates. Using a panel dataset covering a 21-year period, I apply a synthetic control approach to focus on countries that changed their prevailing organ donation legislation from opt-in to opt-out. I compare them to a synthetic counterfactual from countries that have kept their legislation the same since 1999. Synthetic control estimates show that Argentina and Wales achieved substantially higher organ donation rates with the shift from an opt-in to an opt-out system than without the reform taking place. My findings suggest that as one strategy among others, implementing opt-out cannot solve the organ shortage problem entirely but effectively contributes to reducing it considerably.

Suggested Citation

  • Selina Schulze Spuentrup, 2025. "Does implementing opt-out solve the organ shortage problem? Evidence from a synthetic control approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(4), pages 541-560, June.
    • Handle: RePEc:spr:eujhec:v:26:y:2025:i:4:d:10.1007_s10198-024-01716-9
    DOI: 10.1007/s10198-024-01716-9
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    References listed on IDEAS

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    1. Abadie, Alberto & Gay, Sebastien, 2006. "The impact of presumed consent legislation on cadaveric organ donation: A cross-country study," Journal of Health Economics, Elsevier, vol. 25(4), pages 599-620, July.
    2. Alberto Abadie & Alexis Diamond & Jens Hainmueller, 2015. "Comparative Politics and the Synthetic Control Method," American Journal of Political Science, John Wiley & Sons, vol. 59(2), pages 495-510, February.
    3. Alberto Abadie & Javier Gardeazabal, 2003. "The Economic Costs of Conflict: A Case Study of the Basque Country," American Economic Review, American Economic Association, vol. 93(1), pages 113-132, March.
    4. Bibek Adhikari & James Alm, 2016. "Evaluating the Economic Effects of Flat Tax Reforms Using Synthetic Control Methods," Southern Economic Journal, John Wiley & Sons, vol. 83(2), pages 437-463, October.
    5. Fırat Bilgel, 2012. "The impact of presumed consent laws and institutions on deceased organ donation," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 29-38, February.
    6. Mocan, Naci & Tekin, Erdal, 2007. "The determinants of the willingness to donate an organ among young adults: Evidence from the United States and the European Union," Social Science & Medicine, Elsevier, vol. 65(12), pages 2527-2538, December.
    7. Li, Danyang & Hawley, Zackary & Schnier, Kurt, 2013. "Increasing organ donation via changes in the default choice or allocation rule," Journal of Health Economics, Elsevier, vol. 32(6), pages 1117-1129.
    8. Ashok Kaul & Stefan Klößner & Gregor Pfeifer & Manuel Schieler, 2022. "Standard Synthetic Control Methods: The Case of Using All Preintervention Outcomes Together With Covariates," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 40(3), pages 1362-1376, June.
    9. van Dalen, Hendrik P. & Henkens, Kène, 2014. "Comparing the effects of defaults in organ donation systems," Social Science & Medicine, Elsevier, vol. 106(C), pages 137-142.
    10. repec:wly:soecon:v:83:2:y:2016:p:437-463 is not listed on IDEAS
    11. Bibek Adhikari & James Alm, 2016. "Evaluating the Economic Effects of Flat Tax Reforms Using Synthetic Control Methods," Southern Economic Journal, Southern Economic Association, vol. 83(2), pages 437-463, October.
    12. Abadie, Alberto & Diamond, Alexis & Hainmueller, Jens, 2010. "Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program," Journal of the American Statistical Association, American Statistical Association, vol. 105(490), pages 493-505.
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    More about this item

    Keywords

    Organ donation; Opt-out; Opt-in; Presumed consent; Informed consent; Synthetic control method;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • D78 - Microeconomics - - Analysis of Collective Decision-Making - - - Positive Analysis of Policy Formulation and Implementation
    • K32 - Law and Economics - - Other Substantive Areas of Law - - - Energy, Environmental, Health, and Safety Law

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