It led to a culture where the American federal government forced employees to get a COVID-19 vaccine or be fired. Yet 20,000,000 government employees were not given that same ultimatum.
The same mentality has led to countries where companies in the organ transplant business want you to be an organ donor by law. It would create another schism in U.S. culture, where body autonomy remains an issue. There can be no body autonomy if the government can force you to donate your organs.
A new paper says the resulting negative publicity wouldn't help solve the problem - 17 Americans die every day waiting for an organ transplant - and instead of saving 500 more people per year it would likely kill thousands. America was founded because a centralized government ignored their rights and imposed arbitrary laws by force. The authors found that an "opt-out" donation policy, where you are enrolled by the government unless you specifically demand to be excluded, would hurt organ donations.
I have opted in, very few opt out now, yet if government tells me they are taking control of my choice there is a 100% chance I opt out. I will donate a kidney when I am alive before I let government erode one more right in a steady encroachment that has happened since President Clinton began the modern decline of personal freedoms.(1)
Nearly every person with a driver's license opts in(2) and 500 people still die on waiting lists but making the perfect the enemy of the good and tinkering with American psychology is a very bad idea. In the new paper, the authors conducted four experimental studies and tweaked conditions so that there were low available organ donations, etc. to compared opt-in versus opt-out policies.
They found that forcing people to be in unless they opt out didn't increase organs from deceased donors, but it caused a 29% decrease in organs from living donors.
We have seen this psychology in the U.S. many times. Fiscal conservatives donate far more money to charity than fiscal liberals because liberals believe government should handle it. Why will a living person give away an organ if 200,000,000 others have no choice upon dying?
England, The Netherlands and Austria are used to government controlling everything, let them have mandatory organ donations. Nearly everyone whose family moved here in the early years of the country left Europe because Kings and governments were oppressive and if cultural inheritance exists, resentment of government is likely in American psychology for good.(3)
The good news for the 500 that die on waiting lists is that if governments get out of the way, we can make real progress toward organs made from our own stem cells. That means no immunosuppressive drugs, no rejection. In Wired 12 years ago I wrote that we were getting closer, a European team had successfully transplanted tracheas in people who were dying.
Unfortunately, cancel culture came for Dr. Paolo Macchiarini and his team and everyone at the university outside their marketing department who said anything nice about his work. Dying people lack the clear thinking to provide actual informed consent to experiments that might save their lives, it was charged. He was cleared three times by both Karolinska Institutet and their external panel but then Vanity Fair went after him, and a documentary claimed he was some modern form of Frankenstein. That was enough for the university. They fired him. Some scholars resigned because they thought it a political agenda, some resigned because they were in charge when he did his surgeries. The government went after him - for "aggravated assault". Because he performed the surgeries with consent. At the university that recruited him, paid for the work, and promoted him all over the world.
He was convicted on one charge and acquitted on two others and given a suspended sentence. The government appealed and got a judge to agree to a jail sentence and the Swedish Supreme Court refused to hear the case. If that all reads suspect, it is. It really needs a Swedish Kardashian to take up the case.
But the three patients all lived longer than they would have without the surgeries. They were terminal. One lived 700 percent longer. Which means whether or not they were able to give *real* informed consent when they were desperate, or weird charges about animal models not being 'handled' correctly (Gilles-Eric Seralini would be in a French prison for life if that was a concern elsewhere in Europe), the technology worked as proof-of-concept.
And stem cells remain the best hope for transplant patients. Will researchers want to take it up now in a "zero defects" culture, where risky procedures for terminal patients who provide consent and pass Ethics Review will still get government trying you over and over until you are convicted?
Science is already a challenge. When it comes to revolutionary breakthroughs, it is probably not worth the career risk. After all, the COVID-19 technology that saved millions of lives was done by someone who couldn't get government funding, at a school where the department demoted her while she was getting cancer treatment in hopes she would quit. Now both Penn and the NIH take credit for her Nobel prize.
Citation: Pascal Güntürkün, Sinika Studte, Daniel Winkler, Michel Clement, Jonathan H W Tan, Eva-Maria Merz, Elisabeth Huis in ‘t Veld, Eamonn Ferguson, Crowding-out effects of opt-out defaults: Evidence from organ donation policies, PNAS Nexus, Volume 4, Issue 10, October 2025, pgaf311, https://doi.org/10.1093/pnasnexus/pgaf311
(1) Modern, even though Wilson and Franklin Roosevelt were much worse even than Clinton and they weren't that long ago.
(2) Cars are the way you are most likely to die with many organs healthy until Waymo or someone else shakes off the automobile version of 'no GMOs, the modern world is too scary' activists and decides saving 200,000 per year is a good thing.
(3) Unless it is their political party. Democrats were fine with Biden blatantly attempting to ignore the Constitution and Obama's scorched earth approach to health care, while Republicans were fine with President Bush putting the U.S. Army in airports and Trump using Emergency powers to put tariffs on countries that had tariffs on us.
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