 Some ethical questions are raised by penalizing people for not choosing or for introducing monetary encouragement. It may be replied that no one is pressured to donate, as opposed to choose; that the penalties or encouragement are slight; and that transplants are of such value to the needy that any ethical objections are easily overridden. The real difficulty is that mandated choice may not increase retrieval rates by much. In some places where it has been tried (such as the U.S. states of Virginia and Texas), people who are pressured to choose themselves default to “no” (den Hartogh 2008a). In New Zealand, where one must choose as a condition of getting a driving license, the choice is often ignored by intensive care doctors and families because it does not seem like a genuine decision.