Does Nudging Explain Differences in Organ Donation Rates?

by Henry Farrell on July 10, 2011 · 7 comments

in Other social science

It’s great that David Brooks is taking to the NYT to defend NSF funding for the social sciences. This is not the kind of cause that NYT op-ed writers usually take up. Even so, one of the examples of social science in action that he points to is not nearly as clear-cut as he suggests.

Brooks argues:

When you renew your driver’s license, you have a chance to enroll in an organ donation program. In countries like Germany and the U.S., you have to check a box if you want to opt in. Roughly 14 percent of people do. But behavioral scientists have discovered that how you set the defaults is really important. So in other countries, like Poland or France, you have to check a box if you want to opt out. In these countries, more than 90 percent of people participate. This is a gigantic behavior difference cued by one tiny and costless change in procedure.

Contra Brooks, there is no ‘gigantic behavior difference’ cued by a default assumption of opt-in (or, as it is called in the relevant literature, ‘presumed consent’). As Kieran Healy discusses in this 2006 article, presumed consent countries have transplantation rates that are only a little bit higher than informed consent countries. Moreover, the most plausible explanation for this difference isn’t differences in default choices. It’s differences in the quality of organization:

Presumed-consent countries do in fact perform a little better on average than informed-consent countries. I have argued that this is not because of any direct effect of the law on individual choices. Rather, countries with presumed-consent laws are more likely to have paid close attention to the social organization of their transplant systems. High yield cases like Spain and Italy stand out not because their legal systems mandate a different kind of choice for donors, nor because they offer some special incentives for donor families or next of kin. Instead, they have invested effectively in the logistics of the transplant system: they put more staff on the ground, trained them better (especially in the crucial process of requesting consent from families), and improved coordination between the different actors and agencies in the procurement process. Recent research shows that similar reforms may boost donation rates in United States organ procurement organizations.

The just-so story seems to be traceable back to Dan Ariely who notably relies on a relationship between opt-in/opt-out regimes and survey data on whether people would be hypothetically willing to donate organs (this, presumably, is what Brooks is referring to as ‘participation’). But it would appear that this hypothetical willingness does not translate into large scale differences in actual observed behavior. However, the stylized story has become quite widespread among pop-sociology/economics writers, quite likely because it is both appealingly counter-intuitive, and fits neatly with a broader story about the beneficial consequences of policy nudges. Interestingly, blood donation patterns have been the subject of a similar set of controversies, between libertarians who argued for market solutions, and lefties who argued that voluntary donations would be driven out by a market logic (again, reality is more complicated than either of those stylized stories would suggest).

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