On the other hand if most people are donors by default there should be sufficient supply, easing this pressure.
> You might be in a critical state and someone else really needs an organ from someone like you.
How often does it actually happen that an organ recipient and a matching potential donor who is in critical condition are in the exact same hospital at the same time? Is the concern for skewing the incentives real? I’m not even sure where the incentive is in your example—it’s just trading off one life for another. The hospital still wouldn’t be avoiding the potential death of a patient either way.
The issue is that the patient needing the organ might die before the potential donor.
Edit: this is under the assumption that the potential donor is very likely to die of their current condition.
2) one rational argument for opting out is that if you are in a bad state, it might be rational for a doctor to let you die rather than save you, since your organs might be saving multiple people’s lives. I know I was a doctor and I had a 50 year old person in a car crash and I had 3 twentysomethings waiting for a heart liver and lungs I might want to hurry that 50 year old off this mortal coil. It would be the ethical thing to do. But if I was the 50 year old I wouldn’t like it.
And I’m not sure whether you meant that you were a doctor, or was it just a hypothetical, but usually car crash victims are not operated on by organ transplant specialists, so the doctor’s patients will not intersect, making your point purely theoretical.
And while it may seem like the trolley problem, it is not, because there is a huge indirection in whether those organs can be used at all, are required at this time and whether they will truly save someone else. So instead of the still morally questionable 1-3 trolley problem you instead have one where you can either direct the trolley on a track with one person in sight or another with noone on it. And at the distance, both tracks branch randomly and most of them go through 3 young person, and maybe slightly less kills them in the second case.
And while there are bad, even borderline evil doctors out there, I think statistically you are much more likely to find a morally corrupt politician than a doctor, especially in countries with public healthcare.
Most people specify what to be done by issuing a will, but there is not unlimited freedom there. For example, in some countries it is difficult to completely disinherit someone. If there is no will, your property is split in some way among your relatives. The default option, if there are no heirs, is that the inheritance falls to the state.
After death your organs likely won't be able to benefit your relatives, unless they are currently in a life-threatening condition themselves. Dunno how long organs can be kept around, but I doubt that there is no expiry date after which they have to be tossed out. In that case, the organ would have gone to waste by sitting in a freezer.
Therefore, treating your dead body's organs similar to inheritance would make it moral to pursue the default option in most cases, which is donation to the health system. Still, there is the possibility to opt out, which is an extra effort similar to (but way less involved) than issuing a will.
You have the freedom to specify what exactly should be done with your stuff when you die. Whether those wishes will be legally enforced will depend heavily on what they say.
To test this thesis, go to a lawyer in your jurisdiction and ask them about whether it would be possible to split the proceeds of your estate in equal shares with every man in the Greater London area who wears brown shoes on a Thursday, and prepare for a short explanation of administratively workablity.
Then ask about whether you could posthumously fund some international terrorist organisations. Actually, maybe don't.