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School of Law, Duke University




We sought to explore the political feasibility of potential policy reforms to address the shortage of cadaveric organs for transplantation in America. We recruited 730 human subjects from an online population and assigned them to writing tasks that experimentally manipulated the salience of moral and posthumous risks. Subjects read 95-word descriptions of six proposed policy reforms, rating efficacy, morality, and overall support for each. We created weighted estimates of the overall potential support for each reform (WEOS), correcting for the skew in our study population to very roughly approximate the political affiliations of the American public.

The data suggest that cultural cognition and perceptions of risk do not drive policy choices about organ reform. Qualitatively, the writing tasks revealed some ambivalence about the risk of having life-saving organs harvested without consent, and tangible frustration about the risk of a loved one dying for lack of a needed organ.

We found that Democrats were generally more supportive of reforms, while Independents were less supportive, and Republicans were middling in their support. In particular, we found support for the proposal to make the deceased person’s own organ choices controlling rather than deferring to next of kin (WEOS: 54%, with Democrat and Republican levels of support indistinguishable). Respondents did not see personal choice as particularly efficacious for resolving the shortage, but nonetheless morally important. In contrast, respondents perceived opt-out to be highly effective, but morally disconcerting. Nearly two-thirds of Democrats supported opt-out, and nearly half of Republicans did so, a significant difference. Two-thirds of Independents were opposed, however, drawing the WEOS down to 46%.

Even more clearly, we found broad consensus that a regulated market for organs could be effective but would be deeply problematic morally (WEOS: 16%, with no detectable political split). On the other hand, another incentive, the payment of vouchers for funeral expenses, enjoyed stronger support (WEOS: 51% with a majority of both Democrats and Republicans supporting the proposal, but with the former even more so, a 14% split). The voucher assuages moral objections about the market while maintaining apparent efficacy.

Our study also suggests that a package of reforms – including reciprocal preferences, opt-out, and elimination of the family veto – may be feasible politically (WEOS: 53%, and no political split detectable). This package of reforms neutralizes moral objections to a reform based on reciprocal preferences alone (WEOS: 41%, with a significant 10% split along party lines).

This study is best understood as a pilot for a future study with a demographically-valid sample. Still, the richness of the data suggests that Americans make nuanced policy distinctions, which depend on how proposals are packaged. We identify certain reforms that may enjoy broad-based support from across the political spectrum.

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