Increasing organ donation – but not the way you think…


  • Behaviour change
  • Social brain

How do you get 500,000 people to register to be organ donors?  Many people reading this blog may know about the use of default options to very successfully increase registration.  But it seems that there is another way: Facebook.  The use of the social media giant to create a surge of new donor registrations was presented at a conference last week, Social Media and Behavioral Economics.                  

Going with the flow:

In now well-known research by Dan Goldstein and Eric Johnson (described by Thaler and Sunstein in Nudge, by Dan Ariely in one of his brilliant TED talks, and used in nearly any conversation about defaults), the authors show that default options matter – a lot – for organ donation rates.  They found that when the default option was to not be an organ donor - that is, if the participants of the experiment had to change a selection from being ‘not a donor’ to ‘donor’- only 42% of people opted to do so.  But by simply switching the default option to be a donor, with a choice to opt-out, a whopping 82% of people consented.  The results of this work highlight that countries with a presumed consent (opt-out) policy have higher donation rates than those with explicit consent (opt-in) policies.

Countries with a presumed consent (opt-out) policy have higher donation rates than those with explicit consent (opt-in) policies

But why should the default option matter so much?  Especially when decisions are complex or when we really don’t know much about the choice options, we tend to select whichever is the default option.  There are a couple reasons why we might do this:  first, we might assume that the default option is the one that most other people have picked, so we choose it too in response to the sway of a perceived social norm. Or, we might believe that whoever designed the question, called the ‘choice architect’ in behavioural science circles, has some sort of expert knowledge and that the default is in some way the best option for you.

Others still might be simply saving their mental energy or ‘cognitive resources’: it is easier to not change something than it is to change it, so if option A is already selected it is easier to not think about the decision and keep A selected than it would be to consider all of the options and change the selected option to B.

Status update:

Facebook obviously cannot use defaults to encourage donor registration.  This would be equivalent to writing into the Facebook T&Cs that all users agree to be organ donors unless they actively choose to opt-out.  Nor will they make the choice mandatory, so that, for example, when you log in to your Facebook account you would be met with the question of whether or not you’d like to be an organ donor, and are only allowed to use Facebook once a selection has been made.  This would probably be great for donor registration rates, but arguably bad for business.

Instead, Facebook used the power of social norms to encourage people to register.  The campaign made it easy for people to not only register to be a donor, but also – and more importantly for social contagion - to list their organ donor status on their profile and spread the word through the Facebook newsfeed.  Some argue that it was not the social pressure from friends, but the accompanied media frenzy that lead to the surge in donor registration.  In any case, the increase is commendable, with latest figures that I could find stating a half a million new registrations due to the Facebook campaign.  That is a lot of lives that could be saved.

In the initial stages of the campaign, Hawaii saw an 800% increase and Georgia saw an incredible 12,000% increase in online donor registration.  Even Andrew Cameron of Johns Hopkins University, who was presenting this particular set of slides at the conference, asked “12,000%, what does that even mean?”

Both Cameron and Sarah Feinberg (of Facebook) admit that after an initial surge of activity, the registration rates in most areas taper off and eventually level out at pre-campaign rates.  Journalists have picked up on this, too.  But surely this point should be reframed from a failure to an opportunity to reach a better understanding of how to maintain higher registration rates.

Who should decide which campaigns to run?

The event was webcast live but lasted for several hours, so I was only able to tune in from my desk for some parts of the conference and missed much of the moderated Q&A.  But David Talbot writes an excellent piece in the MIT Technology Review where he echoes an important point raised by Jonathan Zittrain of Harvard Law School.  When a social platform reaches a size and level of influence as to affect behaviour on such a scale, should we be wary?   Talbot writes:

‘Once a global social platform wades into social engineering, who decides what deserves such efforts in the future? “I’m not focusing on Facebook in particular,” Jonathan Zittrain, a professor at Harvard Law School, remarked at the event. When a site with more than a billion active users can influence what those users do, it means they are “in a position to make choices which we thought were peer-to-peer,” he said. “We absolutely have to think about a framework about how to account for that.”’

Yes we do.  But overall, although we need to seriously explore issues such as those raised above by Zittrain, the news of the Facebook campaign’s success should be welcomed.

Interestingly, Feinberg mentioned that some countries have asked Facebook not to introduce the organ donor campaign, for fear that it would be detrimental to their existing high rates of registration.  These countries, unsurprisingly, are already using a presumed consent (opt-out) policy.

So Facebook might not be as good at increasing organ donation registration rates as good old presumed consent policies.  But they have done a tremendous job in raising awareness around the issue and their success highlights the staggering power of social norms to influence behaviour.


Nudging towards organ donation: Wales leads the way

Facebook organ donation FAQs

NHS organ donation Facebook page and the NHS BT organ donor webpage

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