THINKER'S ALMANAC - December 23

Subject: Default Effect - Organ Donation

Event: First organ transplant, 1954

If you want to encourage some activity, make it easy. -Richard Thaler

On this day in 1954, the first successful organ transplant operation was performed; it was a kidney transplant.  Today advances in medical technology have made transplant operations routine, including transplants of the heart, the liver, and the lungs.  Unfortunately, the supply of healthy organs for donation is much lower than the demand, and many people die each year before they can acquire a needed organ.

One possible solution to the problem can be found by examining how states acquire consent from potential donors.  Most people are familiar with checking a box to become an organ donor.  This is usually offered to people when they renew their driver’s license.  This method of signing up donors is called “explicit consent”: in order to become a donor, a person must take a specific action.  The problem here is that although roughly 97% of people support organ donation, only 43% take the explicit step of checking the box to sign up.  

An alternative method for signing up donors is called “presumed consent”: all citizens would be automatically signed up as organ donors; however, each would have the choice of opting out by checking a box when renewing their driver’s license.

Based on research by Eric Johnson and Dan Goldstein in 2003, participants were offered the opportunity to become organ donors in both the explicit consent condition and the presumed consent condition. Under the explicit consent condition, only 42% opted in.  In contrast, under the presumed consent condition, where participants had to opt out, 82% agreed to become donors.

More than just an issue related to organ donation, explicit and presumed consent have something to teach us about the default effect, our human tendency to accept default options.  We are basically indecisive individuals, and most often select the easiest option.  For example, many people own an iPhone, but few take the time and effort to customize their phone’s settings; it’s much easier to just stay with the default options.

Economist Richard Thaler and law professor Cass Sunstein wrote a book analyzing how governments can use the default effect to guide the choices of citizens while at the same time not restricting their freedom.  The term they use is “nudge,” which also happens to be the title of their book.  An example of the difference a nudge can make comes from two European countries: Germany and Austria.  In Germany, organ donation is an opt-in program that requires explicit consent; as a result, only 12% of citizens sign up.  In Austria, however, citizens must opt out because their program is based on presumed consent; in Austria, 99% of citizens are organ donors.

Of course, we should not always assume that governments will nudge their citizens towards the most benevolent options.  Therefore, we should be more alert when we are making decisions.  Consider not just what the default option is, but also why it might be the default option.  It’s more cognitive taxing to examine options besides just the default, but often it allows us to expand our perspective and to take advantage of opportunities we wouldn’t have considered otherwise.

 

Challenge - Wink, Wink, Nudge, Nudge:  The example of how Australia nudges its citizens to become organ donors is just one example of how a government might influence its citizens towards positive action.  Do some research on nudges.  Write a paragraph defining the term for a reader who is unfamiliar with it and give a concrete example to illustrate it.

Sources:

1-Thaler, Richard H. and Cass R. Sunstein.  Nudge:  Improving Decisions About Health, Wealth, and Happiness. New York:  Penguin Books, 2008.