Israel’s New Organ Donation Nudge

Israel, which has a history of creatively incentivizing organ donation, will soon be implementing yet another organ “nudge.”  Al Roth shared a recent email from Israeli transplant surgeon (and Freakonomics podcast guestJay Lavee explaining the new policy (which is based on unpublished research by Roth and Judd Kessler): 

Just a short note to let you know that the Israeli Minister of Health has adopted this week my recommendation to establish by law the modified mandated choice model based upon your work, whereby the issuing or renewal of an ID, passport or driving license will be conditional upon answering the question of becoming a registered donor to which only a positive answer will be given as an option or else the “Continue” button will be selected. It seems that, contrary to my previous worries, the entire registration for these documents is currently being done online and therefore there should be no technical issues to implement this model.

Bruce Morton

This is good, but Israel is only interested in getting donations from white people.


It's not based on race, it's based on countries of origin / visited. Lots of countries other than Israel have these parameters. You could argue, blood expert that I'm sure you are, that it's impractical, but it surely isn't racist.

Voice of Reason

There's a simple solution to this: mandate that only those who offer to donate organs will be eligible receive them when they need them. Make it so that it's an exchange. I've never understood why people are able to opt out, but then beg to be on the waiting list when they need help from medical science.

Enter your name...

In the US, I don't believe that there is really an "opt-out". It's more like not signing up for online bank statements: you failed to agree today, but they'll keep asking because you might agree tomorrow.

Outside of an advance directive, your options in the US are actually "yes" and "undecided". If you "refuse" on your driver's license, then there's just an empty blank, rather than "refused". There are people who must not donate their organs (for example, people with leukemia), and there is no registry for "don't take mine, they're poisonous, you don't test for this rare disease, and not all my family members know that I have this and/or realize that it's relevant". They just have to hope that if they die in a car wreck, either the right doctors will be contacted for medical history or that the family member who does know about the issue won't have also been in that fatal wreck. (This is probably a bigger problem for people with few or no living relatives.)