On November 2, 2018 the Frankfurter Allgemeine Zeitung published the article "Die Vorteile einer Entscheidungspflicht" by Prof. Dr. Axel Ockenfels, game theorist and professor of economics at the University of Cologne. Together with Sandro Ambuehl, Swiss economist and Assistant Professor at the University of Toronto, he deals with various possibilities to increase the number of organ donors in Germany in the article. They come to the conclusion that a compulsory decision is the best solution to achieve this goal.

The starting point of their work is the fact that there are too few organ donors in Germany and the associated proposal of the Minister of Health, Jens Spahn. He sees a solution of the problem in the fact that everyone is a donor, if he does not contradict during lifetimes. 

Ockenfels argues that it must be considered how one can induce humans to become organ donors. In addition, one should take into account the reaction of already registered organ donors to changes in the organ donor rules. 

There are many different ways to attract new organ donors. These include financial incentives, which are prohibited in almost all countries, or "nudging", a method without economic incentives and changes in the available options. But also the objection regulation: one is regarded as an organ donor as long as one does not actively oppose it. Although this regulation leads to the fact that there are potentially more organ donors, the number of actual donations is significantly lower. If there is no active decision, the final decision is made by the surviving dependants, who in most cases decide not to donate. This is shown by a study published in the scientific journal "Science". 

The behavioural researchers suggest a different solution. This is the obligation to make a decision. They say, for example, that when applying for an identity card, all people should be obliged to decide whether or not they want to donate. This decision is then registered and can be changed at any time. The advantage of the obligation to make a decision would be that no third party would divide other people into donors and non-donors or encourage them to decide one way or the other in terms of content. This proposal has also been criticized and there is also a lack of experience. However, studies show, that a decision obligation is acceptable for many people. These studies also show that many additional organ donors could be found. 

Axel Ockenfels and Sandro Ambuehl appeal to discuss the alternative of the decision obligation and its variants and to substantiate the discussion with experiments and other data sets.