Organ Donation and Nudging

What’s a decision? "A determination arrived at after consideration", emphasis on consideration. We think of ourselves as decision-makers, free human beings, and yet, in our daily lives, many of the decisions we make are by default rather than involving actual consideration. We use heuristics and biases to make many of our day-to-day decisions, but these biases could be a matter of life or death.

(dramatic pause)

Depending on where you live, your opinion towards organ donation could be skewed in two ways: it’s ethically meaningful and a very serious decision or it’s the most normal thing in the world. This is the public opinion on organ donation in Germany and Austria (respectively), neighboring countries with a shared history and culture.  The difference here is between two different policies, Germany has an opt-in policy for organ donation whereas Austria has an opt-out policy; in Germany, you have to actively register for organ donation (just like in the UK), in Austria you are registered by default. These different policies have dramatic effects. In Germany around 12% of the population is registered as an organ donor, in Austria, it ’s close to 100%. In Germany, organizations have desperately tried to increase the number of organ donations in the past few years, with costly print campaigns and posters (we have not yet reached the 21st century) where “celebrities” self-identify as donors and try to convince you to make a decision and fill out a pass. This didn’t seem to have an effect, on the contrary, the number of registered organ donors in Germany has been falling over years has been falling over the years.
Biases affect our lives in significant ways. The bias most likely at play, in this case, is the status-quo bias; we prefer things to stay the same. We subconsciously expect the default to be there for a reason and to communicate some kind of information about the “right” decision. The government chooses the default in most cases which pushes (or in the fancy behavioral economics term, they “nudge”) us in one or the other direction. This is why countries can’t just simply move from opt-in to opt-out. In Germany, proposers of the opt-out policy have seen a significant backlash, because the status quo is opt-in. People consider the policy in place to already be the right one.

Defaults specifically, and nudges more generally, set out a framework in which we make our decisions, which is why it’s pertinent governments catch up in understanding human behavior. Nudges as a policy tool have been objected for manipulating citizens and implying that “government knows best” (or at least better than we do ourselves), but sometimes it does. The mental shortcuts we take in our day to day lives don’t always lead us to a beneficial outcome for society, or ourselves, for that matter.  We should save for retirement, but we don’t; we should eat healthily, but we don’t; we should be environmentally conscious and use fewer plastic bags, but some of us don’t. By understanding how and why we behave the way we do can help government gently lead us to improved decisions. All this, while still keeping other options open. This is what Richard Thaler (who won a Nobel Prize in economics) and Cass Sunstein (who worked in the Obama administration) call libertarian paternalism; the government suggests an option (paternalism) but we are not restricted in our choices, we can always decide to go the other way (libertarian).

Quick side note on the word paternalism. It means someone’s interfering and restricting choices, implying that the interferer knows better what is right. Notice anything about that word?
If your answer was, “Of course I notice that this word is gendered, Marie”, then 100 points to you.
“Pater” means father in Latin. The background of the political use of the term paternalism stems from the idea that the state should mirror the image of the family, with (of course) the father being the head of the family. I’m not criticizing Thaler and Sunstein for using a word that has been around for ages, just pointing to the fact that our language is gendered, but let’s get back to nudges.

While the idea of government manipulating people in whatever way they like (think Aldous Huxley’s Brave New World) does sound scary, nudges this far usually work on a smaller scale, which also makes them relatively cheap. Most policy examples are small tweaks to existing policies to make them more effective.
Nudge theory in policy making is just getting started, but in terms of manipulation, businesses are way ahead. The product design, advertising and make-up of Mc Donald’s restaurants, for example, are all far from arbitrary, instead, they are carefully designed to get people to buy as much as possible to maximize the firms’ profits. Given this, it is important that governments become at least aware of the possibilities behavioral sciences and subconscious cues open up. The UK already famously established their nudge unit (behavioral insights team) and Australia has something similar

The UK, it seems, has found a way to deal with the organ donor situation. The government will try to switch from opt-in to opt-out and aims to have changed the policy by 2020. Apparently, the most important part was shifting public opinion, and starting a discourse to get people involved will hopefully make people willing to diverge from the status quo.


Side note: I’d be interested in seeing gender differences in organ donor registration. The only studies I found were that women where donor more often than men, whereas men received organs more often (I think the study was concerning kidneys).

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