A simple, no-cost way to increase organ donor registrations

Researchers from Queens University, Boston University, University of Toronto, University of Rochester, and Treasury Board Secretariat, Government of Canada published a new paper in the Journal of Marketing that tests a simple, no-cost intervention that can double registration rates, thus helping communities gradually increase the number of prospective donors.

The study, forthcoming in the Journal of Marketing, is titled "Increasing Organ Donor Registrations with Behavioral Interventions: A Field Experiment" and is authored by Nicole Robitaille, Nina Mazar, Claire I. Tsai, Avery M. Haviv, and Elizabeth Hardy.

Current statistics on organ donation point to an ever-increasing demand, yet inadequate supply of available donors. For example, in the United States, there are over 113,000 individuals currently on the transplant waiting list and 22 people die each day waiting. And the gap between those needing transplants and those receiving them continues to widen. With thousands currently waiting for organ transplants, the need for donors is urgent. One way to address the ever-growing demand is to increase the number of individuals registered to donate. While the vast majority of people support organ donation, many do not take the steps to register.

Low registration rates are especially common in countries with explicit consent registration policies—that is, individuals must opt in to become organ donors—compared to countries with presumed consent policies—where individuals are organ donors by default but can opt out. Although some suggest changing the default may be a promising intervention, the impact on actual donations has been mixed due to, among other things, uncertainties about a deceased person's donation preferences.

Furthermore, changing registration policies involves implementation challenges and ethical considerations surrounding informed consent. To date, most jurisdictions have maintained their existing policies, thus prompting the question, what can be done within explicit consent systems to improve organ donor registration rates? Prior research provides a good understanding of predictors of organ donation attitudes and intentions, yet little is known about how to increase actual registrations.

To address these limitations, the research team conducted a field experiment in the Province of Ontario to test behavioral marketing interventions targeting information and altruistic motives in an effort to increase new organ donor registrations in a prompted choice context. Along with the interventions, the researchers streamlined the registration process (i.e., intercepting customers at the time of decision, handing out promotional materials upon arrival for customers to consider while waiting) and updated the design of the registration form to increase the saliency of their interventions (i.e., a simplified form printed on cardstock using colored accents).

The researchers say that "Our paper contributes to the limited evidence for low-cost and scalable solutions to increase organ donor registrations within the current explicit consent systems. Our field experiment demonstrates how intercepting customers with promotional materials at the right time (an information brochure and perspective-taking prompts), along with other process and design improvements, can increase new organ donor registrations" says Robitaille. Specifically, Tsai points out, "the best-performing condition, prompting perspective-taking through reciprocal altruism ("If you needed a transplant would you have one? If so, please help save lives and register today.") significantly increased actual registration rates from 4.1% in the control condition to 7.4%, an 80% increase."

They add that "We were able to do so without imposing on the freedom of individuals, raising ethical concerns (i.e., changing defaults), or passing new legislation." They illustrate the potential impact of their findings, saying "Assuming that everything held constant over time and we introduced our best performing intervention (reciprocal altruism) together with our process and design improvements Ontario-wide, we could expect roughly 225,000 additional new registrations annually. Given that one donor can save up to eight lives, and enhance 75 others, such an increase could make a meaningful impact on the lives of many."

The research team concludes with "By leveraging behavioral science to design our interventions, this research contributes to understanding how to reduce the intention-action gap in the context of organ donation, improve public policy, and enhance social welfare."