Planet Money | Podcast Review | November 2, 2015 | By

Planet Money #518: “Your Organs, Please”

Life, Death, and the DMV.



When I was in the fourth grade, I had a teacher—Ms. Gross—who said that, if we didn’t know the answer to a multiple choice question, we should always stick to our first guess. Now, for those of you who know me in person, I hope you’ll attest (comments welcome below) that I am a person who doesn’t spend a whole lot of time in my head. My decisions, big and small alike, are quick-draw; no hemming and hawing, no dawdling, no nonsense. I am a man of action, the kind of guy (you know the type) who takes Ms. Gross’s advice to heart—first guess, best guess.

That is to say, none of that is actually even a little bit true—except for the stuff about Ms. Gross… God, was that lady great. I live in my head. I obsess and rethink and unthink and double-think. I fidget and tear at bottle labels. I preoccupy myself over whether or not the lime green Scooby lunchbox was the right choice for me as I entered middle school. (What could I have been if only I had chosen blue?)

F. Scott Fitzgerald once said that “the test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.” 1 What then, I ask you, should one make of the ability to hold three or four opposed ideas in the mind, and still retain—you know, sort of, in a general sense—the ability to amble, awkward and uncertain, in a direction that some might call “forward”? (The answer, I’d guess, is a second-rate intelligence.)

But, sitting outside of myself and looking in, I agree with the sage advice of Ms. Gross: you should stick to your first inclination, particularly when the chips are down. If you’re confronted with a big life decision, I’d say—and not only because it is about to come in rhetorically handy—trust your gut. Thinking (and overthinking) can only get you so far when you’re operating with (as is life) incomplete information.

Which brings me to our topic du jour: organ donation. Michigan’s organ donation rates used to be abysmal. The national average of registered donors hovers somewhere around 50% of the total population. For a long while, Michigan’s rate was in the teens. Over the course of a decade, there was a public health crusade to bring this numbers up. The state tried advertising campaigns with exceptional stories about people with new organs achieving extraordinary things (not effective) and heartwarming family stories about a mother seeing her son’s freckles for the time (somewhat effective). They even sent volunteers to every church event and town fair in the state to sign people up. Their charge? Appeal to people’s empathy. Given the chance, people
would step up to save lives. Or so they thought.

Turns out there’s something even better than empathy: boredom and exasperation. Following the lead of other states, Michigan began asking people to register as a donor at the DMV. They buried the request as one of many questions in the litany of small tortures that entails a trip to Department of Motor Vehicles. The rate of new donors exploded. People, in their haste to finish their business and leave the building, answered yes and zipped through the rest of the tedium as best they could. (Planet Money has some great tape of this happening.)

Some, though, worry that this is troublesome. Did people really want to become donors? Or did they just want to leave? That is to say: is a distracted “yes” at the DMV really sufficient consent to harvest someone’s organs after they have died?

There is a second stage to the donation process: after someone passes away, the hospital informs the next of kin that the deceased was a registered donor and asks permission to begin the organ removal process. At this point, the family has to consider whether this is something their relative actually wanted, or something that they hurriedly agreed to while trying to escape from a bureaucratic hellscape. If I had to guess, most people would be less upset if their organs were left intact after their death (when they preferred them to be donated) than if they had wished to keep their organs in death, and instead had them harvested. For those planning on an afterlife, it seems safer to nix the donation and avoid an uncomfortable post-mortem confrontation.

But quite frankly, I really trust those split-second calls. Thinking about death is uncomfortable; it is really, really hard to do rationally (supposing it is possible at all). Slotting such an emotionally-loaded decision in between choices about vanity license plates and hard-copy receipts is a way to make the decision seem functional and pragmatic. It’s not an “oh God, one day I could die gruesomely” question, but instead a “that sounds like it could help someone, sure. I wonder if there will be a line at Chipotle after this” query. If I could get that sort of distance on other life decisions, I’d be a very happy man.

Like Ms. Gross told me so many years ago: trust your first guess. Or in this case, trust your gut.


  1. From his essay “The Crack-Up.” ^

About the Author

Eric McDaniel is the founder of Audiologue, where he covers 99% Invisible. Right now, his favorite shows are Mystery Show and Cortex. Find him on Twitter @ericmmcd, or by email at eric@audiologue.xyz.

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