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Encouraging organ donor registration: Testing the Impact of ‘Nudge’ and ‘Think’ Strategies

Encouraging organ donor registration: Testing the Impact of ‘Nudge’ and ‘Think’ Strategies. Alice Moseley, Graham Smith & Gerry Stoker Department of Politics & International Relations University of Southampton, Rediscovering the Civic Project, Universities of Manchester & Southampton.

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Encouraging organ donor registration: Testing the Impact of ‘Nudge’ and ‘Think’ Strategies

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  1. Encouraging organ donor registration:Testing the Impact of ‘Nudge’ and ‘Think’ Strategies Alice Moseley, Graham Smith & Gerry Stoker Department of Politics & International Relations University of Southampton, Rediscovering the Civic Project, Universities of Manchester & Southampton

  2. Organ Donation: What’s the problem? • UK Surveys report 65%-90% in favour of donating their organs (New et al 2004) • Yet only 26% on ODR (NHSBT, 2009) • 8000 people waiting for a transplant • 1000 people died waiting in 07/08 • 50% more organs are needed • Gradual increase in donors but gap between supply and demand growing faster (8% per year) (DH, 2008)

  3. ‘Nudge’ • Repertoire of policy tools based around behavioural economics principles (Thaler & Sunstein, 2008) • Heuristics: Cognitive limitations so shortcuts, rules of thumb, eg following the herd or status quo • Loss aversion: We care more about losses than potential gains • Hyperbolic discounting: Calculations that are in our short term but not our long terms interests – ‘Buy now, pay later!’ • Yet preferences are constructed not fixed so amenable to govt influence

  4. ‘Nudge’ • Govts use nudges to encourage behavioural change (by taking on role of ‘choice architect’) • Eg Changing defaults: recognises status quo bias within decision-making • Eg Information provision: Enabling people to make more informed choices • Organ Donation…. From informed consent to presumed consent? Or mandated choice? Changing defaults • Information nudges

  5. ‘Think’ • Rather than nudging citizens, government merely provides opportunities for them to think • Deliberation, dialogue, debate, peer education • Deliberative turn in democratic theory & practice • Focus on collective rather than individual behaviour Organ Donation…. Educative effect of discussing and debating.. Lack of awareness one of biggest obstacles…

  6. Study 1: Organ Donor Registration: The Impact of Information and Deliberation Research Qs • How effective is information provision alone compared to information & deliberation for increasing ODR? • How does information and deliberation affect attitudes towards ODR? Methodology • Post-test only RCT amongst HE students • Data collection via survey administered in lecture theatres

  7. Trial Arms Control group: Questionnaire only Treatment Group A: Information + (NUDGE) Questionnaire Treatment Group B: Information + Dialogue (NUDGE & THINK) + Questionnaire

  8. Flowchart of the intervention Control Group Treatment A Treatment B Step 1 Introduction Introduction Introduction 5 min Step 2 Questionnaire Read info pack Read info pack 15min Step 3 Leave hall Watch video Watch video 10min Step 4 Questionnaire Group discussions 15min Step 5 Leave hall Questionnaire 15min Step 6 Leave hall Tot:60min

  9. Key issues • Dependent on gatekeepers • Permission to link study to actual registration • Non-attendance • Student sample: external validity • Fresher’s Fair contamination

  10. Study 2: The Influence of Defaults on Organ Donor Registration Research Qs • How do informed consent (opt in), presumed consent (opt out) and mandated choice questions impact on ODR? • How acceptable do participants find these alternative systems? Methodology • Post test only RCT amongst HE students • Data collected via online survey

  11. Trial Arms Group 1: INFORMED CONSENT/ OPT IN (Status quo) Group 2: PRESUMED CONSENT/ (NUDGE 1) OPT OUT (Alternative A) Group 3: FORCED CHOICE (NUDGE 2) (Alternative B)

  12. Choice Architecture Group 1: Please register my name on the National Organ Donor Register  Group 2: Please register my name on the National Organ Donor Register  (uncheck the box if you DO NOT want to register your name) Group 3: Please register my name on the National Organ Donor Register Yes  No 

  13. Key issues • Permission to link study to actual registration: will provide opp. to retrospectively re-register • Student sample: external validity • Dealing with non-response/ self-selection bias • May not be possible to include all students: again dependent on gatekeepers

  14. What do we predict will happen? H1:Information & Deliberation > Control H2: Presumed consent/ Mandated Choice both > Informed Consent

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