Just my personal (contraversial) opinion, but I believe that opting out of being a donor should also opt the person out of being a recipient. Include a 12 month waiting period for someone who has previously opted out, but now wants to opt back in to qualify as a recipient to reduce the ability to gain the system.

My slight adjustment to your plan (but probably still controversial):

Anyone can receive a donated organ. But those that do are permanently opted in to donate.

Well, I actually don't think that. People can legitimately change their views and philosophies. The "wedginess" of this rule would probably do more harm to society than the marginal increase in organ availability.

"We could very easily save your life with a transplant, but we won't because you did not choose to be an organ donor" is not something I think people in this country have the stomach for. This would be like if we didn't treat people who opt not to carry health insurance. In theory that prevents moral hazard, but in practice no society would be willing to let people with treatable ailments die.

The NHS has budget constraints so they are making this kind of decision all the time. It’s unlikely to be made by the doctor treating the patient anyway.

You don't say why you want to do this.

I think it's perfectly fine and respectable for someone who opts out of donation to decide for themselves, when the issue faces them, that they won't take a life saving organ.

That's very different from mandating and coercing organ donation in order to be eligible.

Right now, organ donations go to those with the greatest need. You are saying, well no it shouldn't go to people who aren't moral according to my philosophy.

I think you have to consider how that could go wrong, and who might be considered the wrong sorts of people, the sort of people who don't deserve to be treated.

Who might prominent political figures decide are immoral, abnormal, unproductive, unworthy, or unpatriotic?

IIRC this is how it works in Singapore.

Yes, let’s shame and punish people that think differently than "the good way", it will totally help the cause get more support.

There are long waiting lists for organ donors; why should I donate my organs to someone who won't return the favour? I'd rather donate them to someone who would.

But that's only fair.

As an analogy, it's like healthcare/insurance taxes - you pay them regularly in the hope that if you ever need it, they'll pay for you.

Why would you expect to receive an organ if you're not willing to offer yours?

It's not just that; it's punishing people who want to benefit from a system they refuse to "pay" into.

What if I off-shore my earnings to avoid paying tax; what if I vote Republican. Does consenting to organ donation make me a worthy person despite anything else you may disagree with?

Reciprocity is not some outlandish concept: If you're unwilling to help out, you don't get to join the mutual aid pact.

That’s irrelevant. If you just treat organ donation as an exchange system, an “organ-bank club” if you will, you don’t need to bring judgement into it.

Parent post was hinting at judgement though.

No shame, no punishment. It’s just an organ sharing club, join it or don’t join it.

It is also my view on the subject and the way it is in Portugal as well.

Here in Germany I stand in the minority where donation is opt-in, the result being that better not need an organ transplant over here, as it has one of the lowest contribution rates across Europe.

This Deutsche Welle (German Public Television) documentary on the German transplant waiting list is so sad: https://www.dw.com/en/donor-organ-recipients-second-chance-a...

One of the people in the interview is a medical student who does dialysis at night, and it negatively affects his studies and health.

I am a dual US|EU (Croatian) citizen. I also have lived with type 1 diabetes (autoimmune and insulin-dependent) for almost 30 years now. While I have been fortunate that my kidneys have been fine, if I were to need a kidney transplant, I would absolutely live in Croatia long-term (where I live currently) if I needed a donor kidney.

Croatia has an opt-out system, like Portugal.

Croatia has one of the highest kidney transplant rates in the developed world, and in Europe it competes with Spain and Portugal. You really do not have to wait that long for a kidney transplant in Croatia compared to other developed countries. Here is a good writeup on the Croatian transplant system and how it works: https://cdn.intechopen.com/pdfs/27728/InTech-Action_taken_to...

Like everything in similar kinds of scenarios, many strong opt-in advocates would probably change their mind when forced to be on the receiving end.

Anyway, all the best everything stays safe.

Thank you so much. I have always made myself an organ donor, on my drivers' license. Also, my father was an organ and tissue donor, after he died. It was what he would have wanted, so we did it, although it was hard. We have received a couple of thank you cards from anonymous recipients over the years. It is very sad, but it is always touching to receive such a letter.