Beyond the ticked box: organ donation decision-making under different registration systems

Abstract

Objective: To explore how people experience organ donation decision-making under the conditions of an opt-in, opt-out or noobjection registration system. Design: A between-subjects experimental 3 Â 2 design (registration system x preselection). Participants (N ¼ 1312) were presented with a description of one of the three registration systems and went through a mock donor registration process. In half of the conditions, the default option of the system was visualized by a ticked box. After, participants answered questions about their perceived autonomy and perceived effective decision-making. Main outcome measurements: Perceived autonomy, perceived decision effectiveness and registration choice. Results: The preselected box did not impact any of the outcomes. Participants had higher perceived autonomy under the conditions of an opt-in system. There were no differences in effective decision-making across conditions. Registration choices did differ across conditions and educational levels. In the opt-in system, participants more often made an active decision. Lowereducated participants were more likely to choose to do nothing, while higher-educated people more often made an active decision, especially in the no-objection system. Conclusion: Where the opt-out system potentially leads to the highest number of donors, the opt-in system seems better in terms of preserving people's autonomy and motivating people to make an active decision.

Does default organ donation registration compromise autonomous choice? Public responses to a new donor registration system

“…A strong empirical basis to support claims about these unfavorable effects of nudging on autonomy is lacking. In fact, to date the few studies that have empirically investigated the effect of defaults on autonomy showed no or only marginally negative effects in hypothetical scenarios (Michaelsen, Johansson, & Hedesström, 2021;Wachner, Adriaanse, & De Ridder, 2020a;Wachner, Adriaanse, & De Ridder, 2021), also in case of organ donation (Steenaart, Crutzen, & De Vries, 2021). However, results from hypothetical studies may be very different compared to when people are actually confronted with a default nudge in real life (Wachner et al, 2021;Wachner, Adriaanse, & De Ridder, 2020b).…”

Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study

“…This could explain the higher prevalence of uncontrolled donation after circulatory arrest protocols—which require expeditious organ preservation measures—in opt-out countries as compared with opt-in countries 28 29. Other indirect effects are psychological and behavioural, such as increasing people’s awareness and conversations within families about organ donation, influencing the meaning they assign to donating or not donating,30 altering their registration behaviour,31 32 fostering professionals to identify and refer potential donors and approach their relatives when the deceased failed to register any preference, and changing the conversation between health professionals and relatives 6 33. In Wales, an increase in family authorisation rates could be explained by such indirect factors, including increased societal concern about organ scarcity, growing confidence of families in healthcare professionals, and specialist nurses’ training and familiarity with the legislation 34.…”