The meaning of default options for potential organ donors - PubMed (original) (raw)
The meaning of default options for potential organ donors
Shai Davidai et al. Proc Natl Acad Sci U S A. 2012.
Abstract
Rates of participation in organ donation programs are known to be powerfully influenced by the relevant default policy in effect ("opt-in" vs. "opt-out"). Three studies provide evidence that this difference in participation may occur in part because the requirement to opt-in or opt-out results in large differences in the meaning that individuals attach to participation. American participants in Study 1 rated participation as a significantly more substantial action when agreement was purportedly obtained under opt-in rather than opt-out conditions, and nonagreement as a greater abrogation of responsibility when that decision was made under opt-out rather than under opt-in conditions. Study 2 replicated these findings with respondents who live in Germany, which employs an opt-in donation policy, and in Austria, which has an opt-out policy. Study 3 required American participants to rate various actions that differ in the effort and self-sacrifice they demand. As predicted, the placement of organ donation on the resulting multidimensional scaling dimension differed significantly depending on whether it purportedly was made in an opt-in country (where it was considered roughly akin to giving away half of one's wealth to charity upon one's death) or an opt-out country (where it fell between letting others get ahead of one in line and volunteering some time to help the poor). We discuss the relationship between this change of meaning account and two other mechanisms-behavioral inertia and implicit norms-that we believe underlie the default effect in decision making and other effects of policies designed to influence decision-makers.
Conflict of interest statement
The authors declare no conflict of interest.
Figures
Fig. 1.
(A) Judged similarity of organ donation to a set of high-cost/high-involvement actions (e.g., donating 20% of one’s income to charity) vs. low-cost/low-involvement actions (e.g., donating 2% of one’s income to charity) by United States participants regarding an unnamed opt-in or opt-out country. (B) Judged similarity of organ non-donation to relatively substantial/uncommon negative behaviors (e.g., reporting false information on one’s tax return) vs. nonsubstantial/common behaviors (e.g., failing to report some income on one’s tax return). (C) Judged similarity of organ donation to relatively high-cost/high-involvement actions and low-cost/low-involvement actions by residents of an opt-in or opt-out country.
Fig. 2.
Multidimensional scaling solution of ratings of the similarity of nine behaviors in an opt-in vs. opt-out country.
Similar articles
- 'If I donate my organs it's a gift, if you take them it's theft': a qualitative study of planned donor decisions under opt-out legislation.
Miller J, Currie S, O'Carroll RE. Miller J, et al. BMC Public Health. 2019 Nov 6;19(1):1463. doi: 10.1186/s12889-019-7774-1. BMC Public Health. 2019. PMID: 31694604 Free PMC article. - Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study.
Molina-Pérez A, Rodríguez-Arias D, Delgado J. Molina-Pérez A, et al. BMJ Open. 2022 Sep 8;12(9):e057107. doi: 10.1136/bmjopen-2021-057107. BMJ Open. 2022. PMID: 36441113 Free PMC article. - Opt-out defaults do not increase organ donation rates.
Dallacker M, Appelius L, Brandmaier AM, Morais AS, Hertwig R. Dallacker M, et al. Public Health. 2024 Nov;236:436-440. doi: 10.1016/j.puhe.2024.08.009. Epub 2024 Sep 20. Public Health. 2024. PMID: 39305662 - Defaults and donation decisions.
Johnson EJ, Goldstein DG. Johnson EJ, et al. Transplantation. 2004 Dec 27;78(12):1713-6. doi: 10.1097/01.tp.0000149788.10382.b2. Transplantation. 2004. PMID: 15614141 Review. - A systematic review of presumed consent systems for deceased organ donation.
Rithalia A, McDaid C, Suekarran S, Norman G, Myers L, Sowden A. Rithalia A, et al. Health Technol Assess. 2009 May;13(26):iii, ix-xi, 1-95. doi: 10.3310/hta13260. Health Technol Assess. 2009. PMID: 19422754 Review.
Cited by
- What Determines Support for Donor Registration Systems? The Influence of Sociopolitical Viewpoint, Attitudes Toward Organ Donation, and Patients' Need.
Dijker AJM, de Bakker E, Bensen SC, de Vries NK. Dijker AJM, et al. Int J Behav Med. 2019 Apr;26(2):195-206. doi: 10.1007/s12529-019-09777-4. Int J Behav Med. 2019. PMID: 30820923 Free PMC article. Clinical Trial. - An opt-out model for kidney transplant referral: The time has come.
Huml AM, Sedor JR, Poggio E, Patzer RE, Schold JD. Huml AM, et al. Am J Transplant. 2021 Jan;21(1):32-36. doi: 10.1111/ajt.16129. Epub 2020 Jul 5. Am J Transplant. 2021. PMID: 32519382 Free PMC article. - Deceased by default: Consent systems and organ-patient mortality.
Golsteyn BHH, Verhagen AMC. Golsteyn BHH, et al. PLoS One. 2021 Mar 17;16(3):e0247719. doi: 10.1371/journal.pone.0247719. eCollection 2021. PLoS One. 2021. PMID: 33730042 Free PMC article. - Heart transplantation: advances in expanding the donor pool and xenotransplantation.
Jou S, Mendez SR, Feinman J, Mitrani LR, Fuster V, Mangiola M, Moazami N, Gidea C. Jou S, et al. Nat Rev Cardiol. 2024 Jan;21(1):25-36. doi: 10.1038/s41569-023-00902-1. Epub 2023 Jul 14. Nat Rev Cardiol. 2024. PMID: 37452122 Review.
References
- Friedman M. Essays in Positive Economics. Chicago: Univ of Chicago Press; 1953.
- Gilovich T, Griffin DW. Judgment and decision making. In: Gilbert DT, Fiske ST, editors. The Handbook of Social Psychology. 5th Ed. New York: McGraw-Hill; 2010. pp. 542–588.
- Kahneman D, Tversky A. Prospect theory: An analysis of decision under risk. Econometrica. 1979;47:263–291.
- Levin IP, Gaeth GJ. Framing of attribute information before and after consuming the product. J Consum Res. 1988;15:374–378.
- Shafir E. Choosing versus rejecting: Why some options are both better and worse than others. Mem Cognit. 1993;21:546–556. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials