To Boost Organ Donations, All it Takes is a Nudge

Every day, 22 people die waiting for an organ transplant. Twenty-two! That’s just in the United States. Many of these deaths can be prevented – if only people would sign an organ donor card. But only a handful do.

Are people against donating their organs? Hardly. Surveys show broad public support. But most people don’t bother to register. And if they die suddenly, their heart, lungs, kidneys and other parts can’t save someone else’s life.

Several lives actually. One organ donor can save up to eight people.

Is there a way to get more organ donor cards signed? Research by Nicole Robitaille says yes. And it starts with a nudge.

How to Move Attitudes

Robitaille is an assistant professor of marketing at Smith. She studies how consumers make decisions and why they choose to engage in certain behaviours – some of which aren’t always good for them, such as procrastinating or overspending. She also examines how to change population behaviour to improve consumer welfare, fulfil government policy, and drive marketing results.

Not long ago, Robitaille conducted field research with the Ontario government to increase organ donations. In Ontario, someone dies every three days waiting for a transplant. Only a quarter of Ontarians are registered organ donors. How to increase that figure? Robitaille and fellow researchers Nina Mazar, Claire I. Tsai, and Elizabeth Hardy investigated.

In Ontario, as in many jurisdictions, the decision to donate organs happens most often when people renew their driver’s licence. Trouble is, when they walk into a motor vehicle office, people aren’t thinking “organ donation”; they just want to update a licence. So when suddenly asked to become an organ donor, they’re caught off guard, says Robitaille. “And when people are asked to make a decision that they don’t feel they’ve put adequate time and effort into considering, they choose not to decide. They put it off.”

Robitaille and her fellow researchers wanted to make it easier for people to make an informed choice. They tested several options. One, for instance, was to have a government employee hand people a brochure on organ donation when they came in to renew their driver's licence. They could peruse the brochure while waiting in line, so by the time they were called to the service counter, they were more knowledgeable about organ donation.

“When people are asked to make a decision that they don’t feel they’ve put adequate time and effort into considering, they choose not to decide. They put it off”

Working with the Ontario government, they also tested a simplified organ donation consent form with only two questions: “Do you want to be an organ donor?” And a checkbox question: “Which organs will you donate?” Previously, all sorts of personal information was asked for,
most of which the government already had on file.

Then came the nudge. At the top of each consent form, several statements in bold text were tested: “If you needed a transplant, would you have one?” And “How would you feel if you or someone you loved needed a transplant and couldn’t get one?”

Such nudge statements are designed to help indirectly influence a person’s decision, without actually deterring them from making another choice. The term nudge was first made popular in the 2008 book Nudge: Improving Decisions About Health, Wealth and Happiness by Richard Thaler and Cass Sunstein.

The organ donor nudge statement, Robitaille says, helped people put themselves in the position of someone needing a transplant. And it led to a big jump in organ donor registrations.

In an eight-week trial conducted at a ServiceOntario office (where driver’s licences get renewed), they found that with the most effective nudge statement, organ donor registrations rose 143 percent. If rates were to rise similarly across the province, the Ontario government estimates it could increase organ donor registrants by more than 450,000 a year – up from the current number of approximately 200,000. Many of the insights uncovered by Robitaille and her fellow researchers, including the nudge statement, are now used on Ontario’s organ donor consent form.

Robitaille says the results of the study show that business research into consumer behaviour can benefit society. “You hope your work has impact, and to know our work might actually save lives is something quite special.”

—Robert Gerlsbeck

This article originally appeared in Smith Magazine, the alumni publication of Smith School of Business, Queen’s University.