Improving Organ Donation Rates Through Behavioral Design

Most of us have experienced it: a surge of empathy while hearing a story of a life saved because of an organ transplant, or a life lost because the opportunity never arrived. Maybe it was a parent who was given more years with their children, or a young person who didn’t get the second chance they deserved. In these moments, the moral clarity of organ donation feels self-evident. And yet, when it comes to actually registering, many of us hesitate. We get distracted. We tell ourselves we’ll do it later. We freeze when confronted with the topic of our own mortality. And then we move on, unchanged.

That gap between belief and behavior may seem small, but its consequences are anything but. Every day, across the globe, people die waiting for an organ that could have come from someone who meant to register, but never did. The missed opportunities are staggering. In the United States alone, over 100,000 individuals remain on the transplant waiting list, with thousands dying each year before a match arrives. For healthcare professionals and policymakers, these aren’t abstract numbers, they represent patients, families, and system-level failures witnessed firsthand. What may appear as minor individual hesitation accumulates into a massive public health shortfall, leaving a vast reservoir of goodwill untapped.

Public support for organ donation is not the problem. In countries like the United States, the United Kingdom, and Australia, more than 90% of adults say they support donation in principle.¹ But when it comes to actual registrations, the numbers drop significantly. In the U.S., only about 60% of adults are formally registered.¹ In other opt-in countries, rates are even lower. This discrepancy is not driven by cultural resistance or moral opposition. It’s driven by something far more mundane, and more powerful: friction.

Emotional discomfort. Decision fatigue. Vague prompts. Poor timing. A form that’s easy to miss or easy to ignore. These are the real barriers. Traditional campaigns, though well-intentioned, often rely on storytelling and moral appeal. But the systems matter more than we think. Behavioral research has shown that the way we structure choices at the moment of decision can dramatically influence outcomes.²

For those working in healthcare systems, organ registries, or public policy, the implications are clear, and perhaps frustrating. Many of you have spent years working to raise awareness and engage the public, only to watch registration rates plateau. But what if the missing piece isn’t public will, but system design? What if people’s values aren’t broken, the choice environment is? This is where behavioral science offers tangible solutions. By applying proven behavioral tools like default effects, identity priming, friction reduction, and norm reinforcement, we can bridge the gap between intent and action. Organ donation doesn’t need more awareness; it needs better architecture. Over the next sections, we’ll unpack three behavioral design opportunities that can turn passive goodwill into life-saving commitments.