Why is open discussion about organ and tissue donation uncommon?

In short, I think there is not much discussion, because it is a daunting, complex, philosophical, and highly personal issue. I think people are intimidated by it, because most of us are unsure of our beliefs to that level of specificity. I'll get into what I mean by that.

There's a great TED talk by the behavioral economist Dan Ariely discussing a paper by Johnson and Goldstein in which a study was done about people's attitudes about organ donation in several European nations.

Surprisingly, there were two obvious groups of countries: those with high (near 100%) participation in organ donation, and those with low (<30%) participation. One might expect this grouping to be due to cultural or religious differences between countries, but oddly, this doesn't seem to be the case. Countries that you would consider similar in many ways could be found in either group, irrespectively.

There was one factor that correlated strongly: the form at the DMV!

It turns out that the default choice on the form at each nation's respective licensing bureau strongly predicts what people pick!

Dan talks about how one might take the naive view that something that happens after you're dead is, by definition, inconsequential to your life, and that the cost associated with lifting the pen to change it is already more than any benefit could be worth.

The reason he says it's naive is because of course, the decision would have an effect on your life -- just not in any tangible way. You would know and feel something about how your body would be treated after your death. You would know and feel something about the future organ recipient you might be saving. This knowledge might affect your thinking, your mood, your outlook, and future decisions.

Okay, so it matters. Then why are people letting the DMV choose for them?

On to my personal opinion: there are lots of big scary philosophical quandaries out there... take the issue of abortion -- a very philosophical one for sure. In the States (where I'm from), you will rarely encounter a more polarizing issue. People certainly aren't nervous about picking sides in an abortion debate... so why is the philosophic about organ donation different?

I think that it's precisely BECAUSE organ donation participation will not affect you during life that people are so timid.

For example: with respect to an abortion situation, let's say mom wants one and dad doesn't. The "default" policy, whatever it is, will poignantly change life in a way that makes one of them profoundly unhappy in a real, tangible way. Either dad is forced to see a child he wants to have aborted, or mom has to have a child she doesn't think she can support or live happily with. Very real effects. These effects would immediately cause the unhappy parent to react to the current abortion policy, and soon the conversation snowballs into what we have today.

But organ donation is a personal choice that has no tangible effects until after you're dead. There's no strong impetus for polarized debate, because everyone can do what they want without stepping on anyone else's toes (or... fetuses). The consequences are purely theoretical for most individuals.