Does opt-out legislation crowd out living organ donations? A cross-country study

To address the shortage of donor organs, some countries have adopted opt-out legislation, whereby consent for post-mortem donation is presumed unless individuals explicitly object prior to death. However, an increase in post-mortem organ donations may reduce the willingness of relatives to make living donations. We test this hypothesis using data from 26 countries over a 21-year period. Using fatal injuries as an instrument for cadaveric kidney supply, we find a significant effect on living donation rates; 50% of the higher living donation rate observed in opt-in countries can be attributed to a lower supply of cadaveric organ transplants.