The global challenge of organ shortage has grown severe in China because of its large population base. To explore the possible means of solving the serious gap caused by demand imbalance, this study attempts to draw lessons from psychological effects, such as default option effect and choice architecture to improve the overall rates of organ donation and number of organs donated. Specifically, we investigated the influence of the organ donation system and registry form design on organ donor registry participation by conducting three online surveys among college students in China.
In Study 1, we compared the organ donation rate of people with a Chinese cultural background under the “opt-in” and “opt-out” systems. The results were consistent with those of foreign studies that the organ donation rate under the “opt-out” system was significantly higher than that under the “opt-in” system. To examine the optimal design of registry forms under these systems, Study 2 compared the organ donation rates under the organ donation registry forms of different countries/regions between these systems. In the “opt-in” system, we selected Japan, Texas (USA), and New York (USA), whereas we selected Cyprus and Wales in the “opt-out” system. The organ donation rates of countries/regions under the “opt-out” system did not show any significant differences although they were higher than those of countries/regions under the “opt-in” system. However, Japan (which uses the “rejection response mode” in its registry form) shows a higher organ donation rate than the other countries/regions under the “opt-in” system and even features the same level compared with the countries/regions under the “opt-out” system. To investigate the possible effect of the response mode on the organ donation registry form, we designed a “selection response mode” version of the registry form as the manipulated contrast of the “rejection response mode” and found that both the rate of willingness to donate and the number of donated organs were higher in the rejection response mode than those in the selection response mode.
Study 3 mainly focuses on the number of donated organs. We manipulated the response mode and other possible factors in organ donation, namely, the influence on the appearance of donors and the presentation order of organs. Consistent with those of Study 2, the results of Study 3 indicated that using the rejection response mode in registry forms considerably boosted the number of donated organs. Moreover, presenting the organs with the lowest influence on the appearance of donors in an ascending order can reach the highest number of donated organs in rejection response modes.
In sum, these results demonstrate that the “opt-out” system and response mode can effectively promote the organ donation behavior in China. Therefore, policymakers may consider the following suggestions to improve the organ donation rates in China: changing its current “opt-in” organ donation system to the “opt-out” system; or, under the current “opt-in” organ donation system, adopting the rejection response mode in registry forms and presenting the organs with the lowest influence on the appearance of donors first.
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