Applications of Nudges: Organ Donation

After looking at how nudges can be used to promote healthier lifestyles, we move on to organ donation – how can we maximise the number of people agreeing to donate organs while protecting the wishes of the donors and their families?

The reason why organ donation is being considered separately to health is that the two are not directly linked – persuading someone to donate their organs is not going to have any impact on their individual health, although it will affect the health of the beneficiaries of their organs. Regardless, it is still a very crucial matter, as the waiting lists for organs are extensive, often thousands of spaces long, with many dying after going untreated while waiting in the queue for years. Therefore, it is highly important to maximise the number of people who consent to donate their organs in the event of their death – the more people that sign up, the more organs that can be obtained and transplanted, and thus the more lives that can be saved. Nudges can be pivotal in improving this dire situation. For this, we will be looking at default options again. Many countries ask people whether they consent to donate their organs in the case of their death when they are filling in forms for their driving license. However, when the default is that you do not consent, inertia causes major problems. It requires extra effort to read through the terms of the agreement and sign it off, and so people may choose to ignore it out of laziness. This is the case in Germany, which only saw an organ donor consent rate of 12% – minimal when compared to Austria’s consent levels of a staggering 99%.[1] This is because, in Austria, an opt-out system is used – the individuals applying for or renewing their driving license have to specify that they do not consent to donate their organs upon death, or else they are presumed to have consented. Although this can cause ethical concerns, the main reason why people do not opt-in is simply due to laziness, and so if they did not want to take part, then they would have been part of the 1% that chose not to become a donor. These are two very similar European countries, and yet this simple nudge of presumed consent and changing the default caused a difference in consent levels of 87%. In the long run, drastically increasing the number of potential donors can save thousands if not millions of lives, and these people would then go on to continue to contribute to the economy through their jobs and consumption, boosting economic growth while also conserving public health.

However, one problem with using this system of presumed consent is that if the individual does not realise they have been listed as a potential donor and they did not want to become one, then their answer becomes ambiguous. If they proceed to get into an accident and the doctors need to know whether they can remove the organs, they will have to spend precious time consulting the family of the person donating the organs if they consent on his behalf. This can cause confusion and waste the valuable time of healthcare workers, and also places unnecessary strain and sorrow on the family of the deceased individual, who is already grieving from the death and now have to make a crucial decision that can both affect their dead relative’s body and also the lives of the potential beneficiaries of the organs.

[1] Johnson, E.J. and Goldstein, D. (2003). Effective Consent Rates, By Country. Available at: [Accessed 16 Mar. 2022]

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