Questions in Behavioural Economics -  Presumed Consent for Organ Donation

Keshav Dimri considers whether we should move towards a system of presumed consent for organ donation and brings into play behavioural economics concepts such as framing and default behaviour.

It is overwhelmingly clear that the UK’s number of organ donations is much less as a percentage of the population than any of the countries with presumed consent. Indeed, any country that requires explicit consent for organ donation has a much lower effective consent percentage than those countries who simply presume consent.

The reason behind this discrepancy lies in a mixture of what behavioural economists such as Dan Ariely call ‘framing’ and ‘default behaviour’. In ‘framing’, the way a choice is presented affects someone’s decision. In this case, the presentation of a tick-box that must be explicitly ticked to sign up for organ donations compared to a tick-box that must be ticked to exclude oneself from organ donation creates a situation of ‘framing’; one would not be inclined to perform the former since it seems to imply that organ donations are a rare or undesirable thing to sign up for; one would, similarly, not tick the second box because one may view donation, in that case, as the usual thing to do.

‘Default behaviour’ explains phenomena by which people, instead of making a rational choice in every situation, simply do what they are used to doing. In the case of such forms someone may simply ignore or leave all tick-boxes out of habit, borne from the fact that many tick-boxes in forms seem to constitute unsatisfactory outcomes e.g. spam.

Should therefore the UK move to a situation of presumed consent? If these behavioural observations are true then it suggests that we will undergo a large increase in the number of organ donors. This may be beneficial as organ donation is a merit ‘good’ with the positive externality that an increase in the number of organ donors is equal to an increase in the likelihood of lives being saved, and smaller waiting lists. However, there are moral implications to be considered. In the ‘market’ for organ donations there exists a lot of information failure, in the form of imperfect knowledge of the risks/benefits of organ donation as well as a general technical failure in understanding the complexities of donation itself.

For many people organ donation seems to be a bizarre act in which somehow our bodies are mutilated to facilitate some Dr Frankenstein’s evil designs - as humans we seem to have a peculiar attachment (no pun intended) to our organs, even after death. Therefore the question must be asked – is it right to manipulate people when they do not fully understand the process they are getting involved in. By changing to a system of presumed consent we are purposely introducing a situation of ‘asymmetric information’. Are we to be reduced to the level of crooked car dealers?

One could argue that the benefits of the increase in organ donation may outweigh the moral costs of this manipulation. However, there may yet be a solution; If, instead of manipulating a situation of asymmetric information we could try to bridge this information gap – if we hand out leaflets and information brochures about the risks and benefits of organ donation we enable people to make rational and informed decisions and should increase the number of organ donors in an ethical way.

I believe that the opportunity cost of this may, however, be significant when we equate the administrative costs that will presumably take up a lot of the health budget. Much easier and much more effective to simply change the tick-box to a not-tick-box!