The Economics of Organ Donation: Why Opt-Out Saves Money Too

When I advocate for opt-out organ donation, people expect me to talk about lives saved. And I do — because 17 Americans die every day on the transplant waiting list. But there's another argument that doesn't get enough airtime: opt-out systems save enormous amounts of money. The economic case for reforming organ donation policy is just as powerful as the moral one, and policymakers need to hear both.

Dialysis vs. Transplant: A Cost Comparison

Consider kidney disease, which accounts for roughly 85% of the transplant waiting list. According to the United States Renal Data System, the annual cost of maintaining a single patient on dialysis is approximately $90,000 to $100,000. Medicare covers the vast majority of dialysis patients through the End-Stage Renal Disease (ESRD) program, meaning taxpayers bear this cost. A kidney transplant, by contrast, costs roughly $120,000 to $150,000 as a one-time procedure, with annual post-transplant immunosuppression and follow-up costing around $15,000 to $25,000 per year.

The Math Is Clear

• Dialysis patient over 5 years: approximately $450,000 to $500,000
• Transplant patient over 5 years: approximately $200,000 to $250,000 (including surgery and ongoing care)
• Net savings per transplant: roughly $250,000 over five years

With over 90,000 people currently waiting for a kidney in the U.S., even a modest increase in transplant rates generates savings in the billions. Countries that have adopted opt-out systems — including Spain, Austria, and Wales — have seen meaningful increases in donation and transplant rates, which translate directly into reduced long-term healthcare expenditures.

The Broader Economic Impact

The savings extend beyond direct medical costs. Transplant recipients are far more likely to return to work than dialysis patients. A functioning kidney transplant restores productivity, reduces disability claims, and lowers the burden on social services. Studies in The Lancet have estimated that the societal return on investment for each kidney transplant — accounting for healthcare savings, tax revenue from returned productivity, and reduced social welfare costs — exceeds $500,000 over a patient's remaining lifetime.

Why Opt-Out Specifically?

Opt-out systems increase donation rates by changing the default. Behavioral economics tells us that people overwhelmingly stick with whatever option is pre-selected — a principle known as the default effect. When the default is to donate, more people remain registered, more organs become available, and more transplants occur. Spain, which has had an opt-out system since 1979 and complemented it with a robust organizational framework, consistently leads the world in donation rates at over 40 donors per million population — compared to roughly 30 per million in the U.S.

The Policy Opportunity

For legislators weighing the merits of opt-out legislation like New York's Bill A07954, the economic argument should be a powerful motivator. This isn't a policy that requires new spending — it's a policy that reduces spending while saving lives. Every additional transplant that results from an opt-out system represents a patient who is healthier, more productive, and less costly to the healthcare system. In an era of rising healthcare costs and strained budgets, opt-out organ donation is one of the rare policies that is simultaneously compassionate and fiscally responsible.

Changing the default saves lives. It also saves money. It's time for New York to act.