Should We Be “Nudging” for Cadaveric Organ Donations?

Nudging to donate organs: do what you like or like what we do?

“…It is certainly a coercive policy and the question of when people ought to decide on posthumous treatment of their organs is not easy to answer. Nevertheless, it has been discussed as a viable way to overcome a number of problems associated with default rule nudging, some of which we discussed in this paper (Thaler and Sunstein 2008;Hansen 2012;Cohen 2013;MacKay and Robinson 2016;Wilkinson and Wilkinson 2016). Here we want to offer four reasons for why mandated active choice is better than the opt-in and the opt-out systems if upholding the as-judged-by-themselves principle is indeed a policymaker's main objective.…”

“…Irrespective of the actual cause of the default rule's effectiveness, a policymaker will thus commit fewer mistakes-from the point of view of ensuring the satisfaction of people's all-thingsconsidered preferences-under the opt-out system. However, as Zambrano argues in an unpublished article (titled "Fewer mistakes and presumed consent"), mandated active choice is in an even better position to minimize the number of mistakes made if the as-judged-by-themselves principle and the satisfaction of people's all-things-considered true preferences are the policy-maker's primary goals (see also Hansen 2012). Although adopting the opt-out system may indeed result in fewer mistakes committed in comparison to the opt-in system, mandated active choice would result in no (or close to no) mistakes, which is even better.…”

Making Healthy Choices Easier: Regulation versus Nudging

“…Although Thaler & Sunstein (18) have often been presumed to agree with this position, this assumption is actually not true; they prefer to nudge this kind of issue using prompted choice because of ethical considerations similar to those addressed below and because they feel that the real behavioral problem is not getting people to say yes, but is instead getting citizens to register their stance on organ donation-whether that is a "yes" or "no"-a case of negotiating the problem as mentioned above. Wanting to test prompted choice for organ donation, which itself may be considered a nudge (18), the Danish Nudging Network together with the Danish Ministry of Health and the main public webpage addressing public health issues (https://www.sundhed.dk/) tested, in 2015, the effect of adding a pop-up window to this webpage for one month-a pop-up merely encouraging visitors to take a stance-on-taking-a-stance on their organ donor registration status. About 11,000 more updates were made to the donor registry compared with the previous four-month average, an increase of more than 250%.…”

“…Although the perception of preserving liberty is accurate in principle, that citizens are free to choose otherwise, one can hardly apply this perception in every practical context because the nudge approach to behavior change is applied exactly in contexts where we tend to fall short of such principles. This point becomes especially clear in the context of organ donation registration (18). The transition from an opt-in system to an opt-out system may be liberty preserving in principle.…”

The Behavioral Welfare Paradox: Practical, Ethical and Welfare Implications of Nudging

“…The cost of implementing the opt-out policy appears not likely to cost more than the opt-in policy. Hence, it would be hard to argue that this nudge policy is not welfare-improving (though see Hansen 2012).…”