Flipping the Light Switch: New Perspectives on
Default to Donation for Organs and Tissues
Daniel G. Orenstein* and Layne M. Bettini**
Lights on or lights off? This simple decision is the first, basic question
when entering a room. The decision depends on personal preferences and
the circumstances, but the initial position of the light switch does not directly affect the choice. If the switch is “Off,” one can move it to “On.” If it is
“On,” one can leave it be, and so on and so forth. Keeping lights off when
out of a room is environmentally and financially beneficial, and advocates
encourage doing so for both the direct impact and the secondary effects of
encouraging consideration of energy consumption.1 Keeping the switch
“Off” is a simple illustration of a beneficial default, but the principle applies
to more important and complex decisions, as well.
Organ and tissue donation is also a dichotomous choice: consent or decline. In the U.S., forty-two percent of adults are registered as donors.2 Others have noted their support or objection in legal documents (e.g., advanced
directives) or expressed them to family members. For those who have made
an express decision, the type of consent system in place makes little practical difference.3 However, public opinion data indicate that over ninety-five
J.D., Fellow and Adjunct Professor of Law, Public Health Law and Policy Program,
Sandra Day O’Connor College of Law at Arizona State University; Deputy Director, Network for Public Health Law–Western Region; Lincoln Fellow for Ethics and Health Policy,
Arizona State University Lincoln Center for Applied Ethics. The author was employed by
the Donor Network of Arizona in the organ and tissue transplantation field from 2005-08.
The views expressed here are solely those of the author and do not represent the official position of any organization or institution.
J.D./M.D. Candidate, Sandra Day O’Connor College of Law at Arizona State University and Mayo Medical School.
1. See generally Tufts Climate Initiative, Climate change is real . . . . . . turn off your
lights!, http://sustainability.tufts.edu/wp-content/uploads/lightingbrochure.pdf (last visited
May 22, 2014).
2. DONATE LIFE AM., NAT’L DONOR DESIGNATION REPORT CARD: THE CHALLENGE TO
REGISTER MORE ORGAN, EYE AND TISSUE DONORS 7 (2013), available at
3. Emotionally, there may be important distinctions, as discussed infra. This is not to
say that the consent system makes no difference, as evidenced by the failure to recover potential donors who are registered or otherwise specifically indicate willingness to donate be-