While I agree with you that an opt-in donation system does nothing to stop any potential mustache-twirling organ thieves out there, I don’t think that’s much of a real problem for the same reason I don’t think voter fraud is a real problem- very little upside and huge downside for anyone doing it.
What it does address is systemic issues such as the ones I alluded to regarding unequal health outcomes. I for one would not be okay with an opt-out system in the U.S., in part, because I have no doubt that a disproportionate number of donor organs would come from the disenfranchised. You don’t need a cartoonish villain to arrive at this outcome, just our existing inequality of healthcare (see the disparate COVID-19 impact for an example) plus an opt-out system. In the U.S., the prison population is 40% black, despite black people only making up 13% of the general population. I’m not interested in seeing the same (or similarly situated) 13% provide 40% of donor organs just because it strikes technocrats as a more utilitarian outcome.
Policy can’t be made as if for an ideal world; it has to be made for the one we live in and it has to at least make an attempt at addressing second order effects.
Edit: a punctuation.
