Wednesday, September 21, 2011

Choice architecture in Britain: mandated choice for deceased donor registration

The BBC reports: Organ donated 'nudge' for drivers in new DVLA process

"The Driver and Vehicle Licensing Agency already asks if applicants want to be donors - but from Monday an online form will require that the answer is stated.

"Ministers hope it will help improve organ donation rates.

"Less than a third of people are signed up to be organ donors - despite research suggesting that nine in 10 would he happy to be one.

"The situation has prompted much debate in recent years about how best to improve rates.

"Some have called for presumed consent, where it is assumed an individual wishes to be a donor unless he or she has opted out by registering their objection.

"The government has so far rejected presumed consent and instead the Cabinet Office's behavioural insight team has suggested the driving licence idea as part of its "nudge" drive.

"The DVLA's existing scheme is already responsible for about half of the 1m new donor registrations each year.

"As well as becoming compulsory to answer the question, the section will be moved from the end to the start of the DVLA process, so when applicants from England, Wales and Scotland apply for new or replacement licences they will have to say whether they want to become an organ donor or not.

"When a similar scheme was introduced in the US state of Illinois, donor registration jumped from 38% to 60%."

Whether mandated choice will improve organ donation rates (and not just registration rates) is an open question. But isn't it nice that the Cabinet Office has a behavioural insight team...  A tip of the hat to Sunstein and Thaler is in order.

My question about mandated choice is summarized in the following (somewhat out of context) paragraph from Kessler and Roth (forthcoming):

"A “mandated choice” system would also change the way in which individuals became registered donors (see Thaler and Sunstein 2008 and Thaler 2009). Under “mandated choice,” every individual who registered for a driver’s license (or potentially other state or federal documentation) would be required to indicate that he will be an organ donor or that he will not. While there is suggestive evidence that a “mandated choice” policy would (like “opt out”) generate more registration of organ donors (Johnson and Goldstein 2003, 2004), similar concerns arise about whether a change to mandated choice would lead to more donated organs and transplants. While the Uniform Anatomical Gift Act makes registering to be a donor legally binding under an “opt in” policy, failing to register as an organ donor is not a legally binding decision, whereas registering as a person who declines to donate could be legally binding on the next of kin. [Mandated choices could of course be framed so that a negative decision was merely recorded as a decision “not to register as a donor at this time,” but even this less binding formulation might inform next of kin’s beliefs about the deceased’s intentions and wishes.]  Discussions with the staff at the New England Organ Bank suggests that they are able to recover organs from about half of all non-registered potential donors in New England by approaching next of kin. This means that more than half of the people who are not currently registered under “opt in” would need to choose “yes” in mandated choice to increase the recovery rate. Consequently, it remains an empirical question whether a change to “mandated choice” would generate more organ transplants. 

(That's from
Kessler, Judd B. and Alvin E. Roth, ''Organ Allocation Policy and the Decision to Donate American Economic Review, forthcoming.)

1 comment:

Anonymous said...

My concern with opt-out schemes (in any context) is that it's amazing how frequently one's opt-out declarations are forgotten/mislaid if they're inconvenient to whoever wants to "encourage" people to stay opted in. Think of FaceBook and privacy controls....

A scheme involving mandatory choice, with the assumption that absence, for whatever reason, of evidence of explicit choice to be included must be interpreted as exclusion, might overcome that problem.