Underlying wishes and nudged choices.

Abstract

Is the inferred preference from a choice to donate stronger when the choice was made under a mandated rather than the automatic default (nudged choice) legislative system?The answer to this is particularly important because families can, and do, veto the choices of their deceased relatives. In three studies, we asked American and European participants from countries that have either a default opt-in or default opt-out system to take on the role of a third party to judge the likelihood that an individual's "true wish" was to actually donate their organs, given that they were registered to donate on the organ donation register. In each study, participants were randomly assigned to one of the organ donation legislative systems (default opt-in, default opt-out, mandated choice or mandatory). Overall, regardless of which country participants came from, they perceived the donor's underlying preference to donate as stronger under the default optin and mandated choice systems as compared to the default opt-out and mandatory donor systems. We discuss the practical issues that result from using default systems in the domain of organ donation and propose potential ways to ameliorate the uncertainty around inferences of underlying preference from a nudged choice. Word count: 196

Who’s opting-in? A demographic analysis of the U.K. NHS Organ Donor Register

“…Finally, it is important to discuss that whilst undertaking this research, the U.K. government opened a consultation on moving to an opt-out system in England from an opt-in system [37], the findings of which subsequently confirmed that England will move to opt-out as of April 2020 [38]. The system will mirror the one employed in Wales, whereby family will still be consulted regarding donation wishes [39]. Previous transitions to an opt-out system e.g.…”

“…Importantly, in Spain no opt-out register is present and public knowledge of the deemed consent law is minimal [40]. Further, a recent study found that people were more likely to refuse to donate their loved ones organs in an opt-out system than in an opt-in [39]. Examining the impact of opt-out versus opt-in systems internationally, Shepherd, O’Carroll and Ferguson (2014) [41] found that opt-out systems have higher rates of deceased organ donation.…”

Strange bedfellows: Design research and behavioral design

“…The value of using design research to expand behavioral design's conceptions of context can be illustrated most clearly by instances where interventions informed only by behavioral research neglected to consider important social, cultural, or personal contextual issues that are the bread and butter of design research. Organ donation, long used as an exemplar of behavioral design success, presents a clear case where this proved to be an issue: Although "opt-out" interventions can be an effective lever in increasing the number of people designated as organ donors, they are less successful in delivering the impact that actually matters-successful transplants-if they fail to consider the critical context that donor's families' often do not perceive opt-out mechanisms as a valid form of consent (Lin, Osman, Harris & Read, 2018).…”

Nudging: A Lesson in the Theatrics of Choice

“…Moreover, the poster child of nudges-automatic defaults in the organ procurement domainwas not discussed at all; there are many reasons to suggest that they are simply not effective in increasing actual organ donations (Lin, Osman, Harris, & Read, 2017). The nudge techniques that the paper advocates are transparent.…”