Nudging people for Organ donation

Nudging people for Organ donation

In the last few days, I am impressed with the campaign launched by Times of India to motivate people for Organ Donation. It is indeed a public cause with more than 200,000 people on the wait list for a kidney transplant and almost 100,000 for a liver transplant. These numbers may go up drastically if there was more awareness about the number of lives that could be saved with a timely transplant

The law presently allows organ donations from blood relatives. The real challenge is in getting consent of the next of the kin for brain dead patients who cannot be revived but their organs could save lives. Several issues are involved here which range from superstitions, religious, awareness as also having the medical facilities and surgeons capable of doing transplants.

One way many countries have addressed this issue is by using the Opt-In and Opt-Out options for giving consent to Organ donation. Opt In and Opt Out are the two main methods of determining voluntary consent for donors. Countries like Germany use the opt-in option, where you need to explicitly give your consent to be an organ donor, have low rates of organ donation consent. As against this, countries like Sweden, Austria and Spain, where the default option is to be an organ donor unless you explicitly opt out, have almost 100% consent rates of donation. Thus there is a simple way in which we can nudge people into being an organ donor. In most countries, this option is exercised when people fill in their forms for issue or renewal of driving licenses.

Richard Thaler, the celebrated author of the book Nudge, also concludes that Opt-In and Opt-Out options have a major impact on Organ donation consent rates. Another option to boost consent rates is mandating exercising choice. In United States, State of Illinois requires that people must indicate their choice. It’s not surprising that Illinois has a consent rate of 60% against the national average of 38%.

Given the high number of people on organ donation waitlist and the high rate of road accident fatalities we have in India, a simple nudge can make more people aware that they can save someone else’s life by getting an opportunity to give their consent. This can be done when people get their driving licenses or renew them. The default option can be that everyone is deemed to have given their consent to be an organ donor and in case they want to opt out, they would be required to fill another form. The same can be done while registering people under NPR of Aadhaar. This would help create a system that could create chances for saving lives by having organ donors amongst victims of road accidents.

However, such a policy is easier said that implemented. In our cultural context, there might be individuals and organizations who would claim that consent should imply informed consent. Just because people were lazy enough to fill another form or tick a box that said ‘I do not want to be an organ donor’, we must not presume their consent. Then there would be cases that would ultimately require consent of the kin also as in our country people still do not accept that brain dead people are dead as they have hopes of reviving anyone who is not completely dead. In order to overcome these issues, we will need an awareness drive by making people aware of the policy as the value it will have for saving lives. Once this message reaches more people, and more people are enrolled automatically on organ donor lists, everyone will have a greater chance of getting an organ, in case they ever needed. 

One can also follow the Singapore model where the Human Organ Transplant Act enrolls almost everyone above 21 years of age to be organ donors and those who don’t opt out also get a higher priority in receiving a deceased person’s organ if they ever needed such a transplant in future.

In United Kingdom too, the Nudge unit set up in the Prime Minister’s office is using insights from behavioral science to prompt more people in giving their consent for organ donation. This also seems logical as studies have shown that though more than 90% people desire to be organ donors, only about 29% people actually sign up to be a donor.

Thus there is an opportunity to be tapped. Nudge and behavioral sciences can help increase organ donation rates in India too and save precious lives.

Abhishek Singh