Choice Architecture: Behavioural Economics as a Catalyst for Organ Donation

 

We are in the midst of an organ crisis. The government believes it can be eased through the use of a tool called Behavioural Economics. In this blog, we explore the issue and how a change in government policy can save lives.

How often do you think about your power to change lives? What if exercising that power was as simple as not saying ‘no’? In the UK’s opt-out organ donation system, your silence can speak volumes. Although many overlook organ donation, it holds immense power to save lives. In fact, 3 people die every day across the UK as a result of the organ shortage (NHS 2024). Behavioural Economics delves into how psychological, social, cognitive and emotional factors influence economic decisions, revealing why policies like the UK’s opt-out scheme can effectively boost donor rates. This post explores how applying these behavioural insights and subtle nudges in decision-making can significantly boost donor rates and save lives.

So, What is Behavioural Economics?

Traditional economic theories are hinged on consumers following rational models of behaviour. However, humans are imperfect and often act in ways that can't be explained through basic utility-maximising assumptions. Behavioural Economics explains these nuances in human preferences and deviations from rationality by recognising the influences of cognitive biases, emotions, social norms and other psychological factors.

To better understand this, let's delve into a few key concepts. When approaching a decision, consumers act from their unique reference point. This is tainted with biases as it is based on a range of information developed through past consumption experiences, our expectations, beliefs, associations, and stereotypes. Heuristics, similarly to biases, are irrational mental shortcuts used to simplify complex decision-making processes based on experience and belief instead of rationality. These alongside social considerations like social norms, fairness, altruism and each individual's morality, shape how humans approach decision-making. By acknowledging that humans don’t always act rationally we can aim to nudge consumers towards desired outcomes through something called Choice Architecture. Choice Architecture nudges decision-making without restricting choice in a variety of ways, such as:

Framing:

• It is important to recognise the influence framing can have on decision-making. How information is presented can greatly influence perceptions, judgements and decisions.
• For example, framing smoking negatively by saying 15% of smokers get lung cancer, as opposed to 85% of smokers living cancer free could lead to more desired outcomes for society.

Nudge Theory:

• This aims to make the desired choice the path of least resistance, thus nudging people to make the desired decision.
• Default options are an example of a nudge. Making organ donation the default, increases donation by reducing cognitive effort and taking advantage of our laziness.

Figure 2

Source: https://images.app.goo.gl/GaCdFz39kKJyZnYBA

The Power of Defaults in Organ Donation

As it stands, 7483 people are currently waiting for an organ transplant in the UK (NHS 2024). The first country in the UK to introduce an opt-out system was Wales in 2015 (Madden et al 2020). Following success in Wales, England decided to move to an opt-out system. This was also driven by the fact that 80% of people in England support organ donation but only 38% had opted in (GOV.UK, 2019). To bridge this disparity, an opt-out scheme could be the nudge needed to save lives by removing the obstacle of opting in. Behavioural insights could increase the number of organs available for transplants.

Implementing Choice Architecture in Organ Donation Policies

A large-scale trial by the NHS Blood and Transplant (NHSBT) department tested the effectiveness of different messages on the GOV.UK webpage encouraging organ donor registration. The best-performing message, which drew on ideas of reciprocity and fairness, led to 1,203 more registrations when compared to the control group during the trial period. This resulted in approximately 96,000 additional completed registrations over a 12-month period (GOV.UK 2024). Framing involved in the trial demonstrated that negatively framed messages highlighting the detrimental consequences of inaction, can be more effective than positively framed messages in preventing people from opting out.

However, Behavioural Economics does have its limitations...

Presuming consent from the general public, could raise ethical concerns. It could be argued to be an infringement upon individual agency and autonomy, especially as people may be unaware that they are opted into donation by default. Cultural and religious beliefs regarding the treatment of the body after death could discourage organ donation. In such cases, the automatic opt-in system or framing techniques may not be sufficient to overcome deeply held religious convictions. To address this, engaging with individuals, communities and religious leaders is crucial to fostering a dialogue about the compatibility of organ donation with their beliefs. By working together to find common ground and emphasising the life-saving potential of organ donation, the UK may be able to develop targeted interventions that respect religious beliefs while still encouraging organ donation registration. In addition, implementing an opt-out system where individuals are automatically registered as organ donors, can guide people towards a desired outcome without restricting their freedom of choices.

So, what have we learnt from all this?

The organ shortage crisis demands innovative solutions. Behavioural Economics provides a powerful toolset that leverages psychological insights to "nudge" people into organ donation. By shifting to an opt-out system, and using effectively framed messages, the UK has the potential to significantly reduce organ shortages.

However, a nuanced approach is crucial. Respecting religious beliefs and fostering open communication with individuals and communities is essential. While opt-out systems can be effective, they shouldn't come at the expense of individual agency. As we consider the organ shortage crisis through the lens of Behavioural Economics, it is essential to remember that behind every statistic is a person waiting for a chance of survival. How will you contribute to this life-saving mission? Could something as simple as doing nothing be the most altruistic decision you ever make? 

Bibliography

Applying Behavioural Insights to Organ Donation: preliminary results from a randomised controlled trial. (2024).

Department of Health and Social Care (2019). Opt-out organ donation: Max and Keira’s Bill passed into law. GOV.UK.

Every day across the UK someone dies waiting for an organ transplant. - NHS, (2020). ‘Organ Donation Law in England’, Organ Donation Law in England

Madden, S., Collett, D., Walton, P., Empson, K., Forsythe, J., Ingham, A., Morgan, K., Murphy, P., Neuberger, J. and Gardiner, D. (2020). The effect on consent rates for deceased organ donation in Wales after the introduction of an opt‐out system. Anaesthesia, 75(9), pp.1146–1152.

NHS, (2024). ‘Organ Donation and Transplantation - Activity Figures for the UK as at 12 April 2024’, https://www.organdonation.nhs.uk/helping-you-to-decide/about-organ-donation/statistics-about-organ-donation/