心理学报, 2018, 50(8): 868-879 doi: 10.3724/SP.J.1041.2018.00868

“以小拨大:行为决策助推社会发展”专栏

以小拨大:默认选项和反应模式效应助推中国器官捐献登记 *

黄元娜, 宋星云, 邵洋, 李纾,, 梁竹苑,

中国科学院大学心理学系, 北京 100049

Nudging: Default option effect and response mode promote organ donor registry participation in China

HUANG Yuan-Na, SONG Xing-Yun, SHAO Yang, LI Shu,, LIANG Zhu-Yuan,

Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China

通讯作者: 梁竹苑, E-mail:liangzy@psych.ac.cn 李纾, E-mail:lishu@psych.ac.cn

收稿日期: 2018-03-12   网络出版日期: 2018-08-07

基金资助: * 国家自然科学基金项目(71471171, 71761167001), 北京市自然科学基金项目(9172019)资助.  

Received: 2018-03-12   Online: 2018-08-07

摘要

器官短缺是全世界共同面临的难题, 中国器官短缺形势尤为严重。为填补中国器官供需不平衡导致的严重缺口, 本研究试图借鉴行为经济学手段中的默认选项、选项架构等心理学效应, 兼顾总体器官捐献率和捐献器官的数量, 探索提高中国器官捐献水平的可能方法。本研究以中国在校大学生为样本, 通过3个调查研究考察了器官捐献制度和器官捐献登记表设计对我国民众器官捐献登记的影响。研究1在器官捐献制度层面上, 发现在中国文化背景中, “决定退出”制度比“决定参加”制度下的器官捐献登记率更高。研究2在器官捐献登记表设计层面上, 比较采用不同捐献制度的国家/地区的捐献登记表形式对器官捐献登记率的影响, 发现在决定退出制度中的器官捐献率高于决定参加制度, 且前者内各种形式间无明显优劣之分; 但在决定参加制度中, 采用拒绝反应模式登记表形式的器官捐献率最高, 甚至与决定退出制度下的各登记表形式相比不相上下。研究3在具有潜在器官捐献意愿人群中, 探索提高捐献者愿意捐献器官数量的可能途径, 发现使用拒绝反应模式的捐献登记表能够增加捐献登记的器官数量; 且低影响外观器官的捐献率在拒绝反应模式下以升序排列时最高。这些结果说明, 决定退出制度和反应模式等行为经济学手段可以有效助推中国器官捐献行为。鉴此, 政府和相关机构可考虑采取如下措施提高中国的志愿器官捐献水平:或改现行的“决定参加”为“决定退出”的器官捐献制度; 或在现行的“决定参加”器官捐献制度下, 在器官捐献登记表中采用拒绝反应模式, 并按对外观影响大小升序排列捐献器官种类。

关键词: 器官捐献 ; 助推 ; 默认选项 ; 反应模式 ; 顺序效应

Abstract

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.

Keywords: organ donation ; nudging ; default option effect ; response mode ; sequence effect

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本文引用格式

黄元娜, 宋星云, 邵洋, 李纾, 梁竹苑. 以小拨大:默认选项和反应模式效应助推中国器官捐献登记 * [J]. 心理学报, 2018, 50(8): 868-879 doi:10.3724/SP.J.1041.2018.00868

HUANG Yuan-Na, SONG Xing-Yun, SHAO Yang, LI Shu, LIANG Zhu-Yuan. Nudging: Default option effect and response mode promote organ donor registry participation in China[J]. Acta Psychologica Sinica, 2018, 50(8): 868-879 doi:10.3724/SP.J.1041.2018.00868

1 前言

器官短缺是全世界共同面临的严峻问题。捐献和移植全球观察站(Global Observatory on Donation and Transplantation, 2014)的数据表明:2014年全球器官移植总数量达到119,873例, 虽然较2013年提升了约1.81%, 但器官供应数量仍不足需求量的10%, 全球器官短缺形势依旧严峻。

中国的器官短缺问题尤为严重。与其他国家相比, 庞大的人口基数使中国的器官短缺形势更加严峻。截至2018年3月28日, 中国公民逝世后自愿捐献累计16,523例, 实现捐献器官446,505个(中国红十字会中国人体器官捐献管理中心, 2018), 然而全国每年仍约有30万因器官功能衰竭而等待移植的患者, 供需严重失衡(Huang, Mao, & Millis, 2008; 中国红十字会中国人体器官捐献管理中心, 2018), 导致急需器官移植的患者在长时间等待中死亡。中国的人均器官捐献率也远低于其他国家。如西班牙的百万人口器官捐献率(Organ Donation Rate Per Million Population, PMP)为34.23, 美国为25.68, 而中国仅为2.98 (孙振, 2017)。中国捐献者的人均器官捐献数量也远低于世界水平:理想情况下每一位捐献者能够捐献8个器官, 目前世界水平是每位捐献者捐献4.00个器官, 而中国每位捐献者仅捐献2.76个器官(Global Observatory on Donation and Transplantation, 2014; 中国红十字会中国人体器官捐献管理中心, 2018)。与此同时, 制度上的滞后加重了中国的器官短缺问题。20世纪60年代, 中国开始了器官移植手术(Huang et al., 2012), 但直至2007年才出台第一个《人体器官移植条例》(中华人民共和国中央人民政府, 2007), 首次对人体器官移植进行了定义。梏于器官捐献制度的缺位, 在很长一段时间里, 死囚一直是中国器官移植最主要的供体来源。2015年起, 中国废除死囚器官使用, 公民自愿捐献成为器官移植的唯一合法来源。因此, 提高公民自愿捐献率和捐献数量成为缓解中国器官短缺痼疾必不可少的途径。

为应对器官短缺这一世界性难题, 近年来各国政府开始借助行为经济学手段来助推(nudge)器官捐献行为。助推研究旨在通过提供简约且低成本的选择架构(choice architecture)等行为经济学手段, 促使人们的行为朝着预期的方向改变(李纾, 2016), 并已在促进人们健康行为等领域展现了较好的应用价值。因此, 本研究将立足于中国的器官捐献现状, 尝试从两条途径着手助推中国器官捐献行为:一是提高中国总体人群的器官捐献率, 二是在已有捐献意愿的人群中, 增加捐献者愿意捐献的器官数量。具体而言, 本研究分别从器官捐献制度和器官捐献登记表的选择架构两个层面出发:(1)基于国际主流的决定参加/决定退出器官捐献制度, 对比两种制度在中国文化背景中的捐献效果; (2)借鉴世界各国的器官捐献登记表设计, 基于中国国情优化器官捐献登记表的选择架构, 为解决中国器官移植短缺问题提供可能的操作方案和行为手段。

1.1 助推器官捐献的行为经济学手段

助推器官捐献的行为经济学手段可以分为两个层面:器官捐献制度的设计和器官捐献登记表的设计。其中可能涉及的行为经济学效应包括默认选项效应、反应模式等。

1.1.1 器官捐献制度设计:默认选项效应

默认选项(default option)指当个体未能做出决策时所要接受的选项(Brown & Krishna, 2004; Johnson & Goldstein, 2003)。当个体的价值或偏好还未成形时, 其决策就会被框架所影响, 这时默认选项就被当作了参照点(Johnson, Bellman, & Lohse, 2002; Kahneman & Tversky, 1979; Payne, Bettman, & Johnson, 1992)。因此, 当存在默认选项时, 人们决策时倾向于保留默认选项而不做出改变, 这就是默认选项效应(default option effect) (Altmann & Grunewald, 2013; Dinner, Johnson, Goldstein, & Liu, 2011; 黄宝珍, 徐富明, 王岚, 马向阳, 吴修良, 2011)。

默认选项效应在器官捐献领域的应用主要体现在两种捐献制度上:传统的“决定参加” (opt-in, 即默认每个人都不是潜在器官捐献者)制度和新近的“决定退出” (opt-out, 即默认每个人都是潜在器官捐献者)制度(van Dalen & Henkens, 2014)。众多研究(Abadie & Gay, 2006; Delriviere & Boronovskis, 2011; Johnson & Goldstein, 2003; Li, Hawley, & Schnier, 2013; van Dalen & Henken, 2014; Zúñiga-Fajuri, 2015)表明, 采取决定退出制度可以大大提升捐献率。例如, 决定退出制度的国家中(如西班牙等), 超过90%的公民选择成为器官捐献者, 而在丹麦等决定参加制度的国家中, 平均仅不到20%的公民选择成为器官捐献者(Johnson & Goldstein, 2003)。Johnson和Goldstein (2003)发现决定退出制度下的器官捐献率高于决定参加制度。同样, 有研究分析了1992~2002年间22个国家的器官捐献率, 发现采用决定退出制度的国家具有更高的器官捐献率(Abadie & Gay, 2006)。

但关于两种制度捐献效果的研究结论仍存在争议。首先, 决定退出制度饱受法律和伦理的争议:该制度实质上重新定义了死者器官的所有权, 由亲属拥有转移到政府拥有。其次, 一些实践和研究也表明, 决定退出制度并未如宣扬那般有效:一方面, 有些国家改用决定退出制度反而降低了器官捐献率。如巴西改为决定退出制度后, 捐献率不升反降, 最后不得已而废除(Kaushik, 2009); 智利2010年改为决定退出制度后, 其同年器官捐献率相比于前十年间的平均捐献率降低了29% (Zúñiga-Fajuri, 2015), 还进一步引发了亲属同意率下降等问题(Domínguez & Rojas, 2013)。另一方面, 决定退出制度的效果可能被普遍高估。如比利时在1986年采用决定退出制度后, 器官捐献率提升了55%, 但当时采用决定参加制度的英国, 器官捐献率在1985~1990这5年间依旧提升了35%, 同一时期欧洲各国家器官捐献率同样在提升(Fabre, 1998)。虽然已有中国学者(吴幼民, 朱继业, 2011)建议中国使用决定退出的器官捐献制度, 但该建议仅基于“他山之石”的理论设想, 缺乏基于中国文化情境的实证数据支持, 目前亦未见研究证据表明该制度在中国是否有效。

因此, 鉴于智利等国失败的教训以及改变制度的较高成本, 本研究的首要任务即是验证决定退出制度在中国文化背景中是否能如愿提升器官捐献率。

1.1.2 器官捐献登记表设计:登记表的架构和呈现方式

器官捐献登记表是在登记器官捐献意愿时用于采集捐献者个人信息的表格。通过设计器官捐献登记表架构, 可能可以提高器官捐献率, 如登记表中的选择反应模式, 或改变器官的排列顺序等。但这些设计与器官捐献率是否存在直接的因果关系, 却缺少相关证据。

决策者做出的决定通常以“接受” (accept)或“拒绝” (reject)反应模式(response mode)表现出来(李纾, 2016)。大量研究发现, 反应模式会影响人们的选择偏好(Chen & Proctor, 2017; Mourali & Nagpal, 2013)。例如, Shafir (1993)发现在二择一选择任务中, 决策者在接受或是拒绝反应模式下选择某一选项的比例均高于另一选项, 出现了决策偏好反转现象。同时, 反应模式也会影响人们招聘应聘者等决策行为(Ganzach, 1995)。目前反应模式已被应用在器官捐献登记表中。如日本的器官捐献登记表存在两种不同的反应模式:“在您不想要捐献的器官前面打叉(×)”或“请在您想要捐献的器官前面打勾(√)”。但两种反应模式是否会对捐献效果产生不同影响, 尚缺乏研究证据。

顺序效应(sequence effect)指刺激呈现的顺序可以影响人们的判断。已有研究报告, 刺激呈现顺序会影响人们的公平判断(李文静, 郑全全, 姚乃琳, 2009)、类比推理(唐慧琳, 刘昌, 2004)和应急决策中的信息判断(Jiang et al, 2013)等, 进而影响自己的知识构建和认知判断。假如将选项由易到难排列, 还可能出现登门槛效应(foot-in-the-door technique), 即一旦个体服从了一个小要求, 会更可能服从较大的要求(Freedman & Fraser, 1966)。顺序效应的优势已在健康领域的助推研究中初见成果, 例如, 放置在菜单顶部和底部的食品选择比例比放置在中部多20% (Dayan & Bar-Hillel, 2011), 突出摆放在前面的健康食材会导致消费者对健康食材的选择增多(Policastro, Smith, & Chapman, 2017)。利用登门槛效应, 亦可使多伦多居民对癌症协会捐款的比例由46%提升至100% (Pliner, Hart, Kohl, & Saari, 1974)。与此类似, 2009年美国德克萨斯州采用登门槛技术设计器官登记表:先询问公民几个简单易接受的问题, 最后再询问其器官捐献意愿。但该举措的实施效果并不明确(van Dalen & Henkens, 2014):有报告指出德克萨斯州的器官捐献率在美国排名倒数第三(National Donor Designation Report Card 2014, 2014), 但也有报告显示其器官捐献率在2013~2014年间提高了25% (Donate Life Texas 2014 Annual Report, 2014)。目前罕见实证研究考察器官捐献登记表中器官排列顺序对器官捐献的效果。

1.2 研究概观

综上, 器官捐献是自愿亏待自己却造福于民的行为(Zhao et al., 2017)。本研究试图借鉴行为经济学手段中的默认选项、选项架构等心理学效应, 基于器官捐献制度和器官捐献登记表设计两个层面, 在总体器官捐献率和捐献器官的数量两个指标上, 探索提高中国器官捐献水平的经济有效的可能方法。研究1在器官捐献制度层面上, 比较“决定退出”和“决定参加”制度在中国文化背景下的捐献效果, 从而挑选能适应中国国情的、更有效的捐献制度。研究2在器官捐献登记表架构的层面上, 比较并借鉴各国器官捐献登记表设计在中国文化背景下的捐献效果, 从中确定在“决定退出”或“决定参加”制度下更有效的器官捐献登记表设计架构。研究3旨在进一步探索如何提高潜在捐献人志愿捐献器官的数量, 考察器官捐献登记表呈现形式中顺序效应、反应模式的综合作用, 冀改进完善中国器官捐献登记表的设计形式。

2 研究1:“决定参加”与“决定退出”的默认捐献制度对器官捐献率的影响

2.1 研究目的

在中国被试中对比决定参加与决定退出两种默认捐献制度下的捐献效果, 探索决定退出制度是否具备帮助缓解中国的器官短缺现状的潜能。

2.2 研究方法

2.2.1 被试

被试为中国科学院大学本科生或研究生215人, 其中无效问卷20份:9人未填写捐献器官意愿问题, 4人在所有问题中做出相同答案, 7人已登记成为器官捐献志愿者或自己/亲友有器官捐献经历/需求, 认为其对器官捐献已有明确态度, 非本研究考察对象, 不纳入后续分析。最终有效被试195人, 其中男性96人, 平均年龄22.51 ± 1.19岁。

2.2.2 研究设计和流程

问卷以纸质形式(共101份)或通过网络(问卷星, www.wjx.cn)发放(共94份), 约5~10分钟完成。被试首先填写知情同意书, 随后被随机分配至各任务条件。

问卷包括两部分。其中, 器官捐献意愿问题改编自Johnson和Goldstein (2003)Van Dalen和Henkens (2014)的实验材料, 要求被试通过二择一报告是否愿意成为器官捐献者。器官捐献意愿问题采用单因素(默认选项:决定参加、决定退出、对照)被试间设计, 被试被随机分配完成一个版本的问题。各版本问题如下:

决定参加组:

假设你搬到一个新地区生活。该地区的器官捐献政策规定, 每个人都不会自动成为器官捐献者。你需要登记注册才能够成为器官捐献者, 你会怎么做?

决定退出组:

假设你搬到一个新地区生活。该地区的器官捐献政策规定, 每个人都会自动成为器官捐献者。你需要登记注销才会取消器官捐献者身份, 你会怎么做?

对照组:

你愿意成为器官捐献者吗?

第二部分为人口统计学信息, 包括性别、年龄、宗教信仰以及器官捐献相关知识和经验。其中, 器官捐献相关知识共16题, 考察被试对器官捐献的了解程度(谢文照, 2013)。如, “捐献者可以指定将器官捐献给某位特定人员”。由于该量表区分度不高(各研究中正确率分别为73.97%, 70.60%和70.18%), Cronbach's α系数过低(各研究中Cronbach's α系数分别为0.15, 0.18, 0.14), 未纳入后续分析。器官捐献相关经验题目共8题, 旨在筛选出对器官捐献已有明确态度的被试, 要求被试报告是否了解器官捐献、是否已登记了器官捐献意愿、自己/亲友是否有器官捐献的经验或需求等。

2.3 结果与讨论

3种实验条件下被试样本分布及捐献率描述统计结果见表1。为控制各组样本在人口统计学等信息上的差异, 我们进行了单因素方差分析与卡方检验。结果显示, 3组被试在性别、年龄、是否信仰宗教的人口统计学变量和器官捐献知识问题得分的分布上均无显著差异(ps > 0.10)。考虑到有宗教信仰被试中各宗教人数过低, 因此, 本研究使用“有宗教信仰的比例”作为测量宗教信仰的指标。

表1   各器官捐献制度组被试的样本分布及其器官捐献率

实验条件 n 男性比例 年龄(M ± SD) 有宗教信仰的比例 器官捐献知识正确率(M ± SD) 器官捐献率(M ± SE)
对照组 74 45.96% 22.66 ± 1.34 6.76% 72.3% ± 11.7% 59.46% ± 6.00%
决定参加 60 51.67% 22.48 ± 1.19 3.33% 75.0% ± 10.2% 68.33% ± 4.74%
决定退出 61 50.82% 22.35 ± 0.97 3.28% 74.8% ± 10.5% 83.61% ± 5.72%

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本研究建立了逻辑回归方程考察器官捐献制度对器官捐献率的作用, 考虑到性别、年龄和宗教信仰可能会对器官捐献登记产生影响(王黎, 张晓萍, 2010), 我们把这些变量作为控制变量加入逻辑回归方程。结果发现, 模型伪确定性系数Cox & Snell R2 = 0.113, Nagelkerke R2 = 0.160, 决定退出制度下的器官捐献率显著高于决定参加制度(z = 2.02, OR = 2.53, p = 0.044)与对照组(z = -3.08, OR = 3.85, p = 0.002)。该结果说明, 在中国文化背景下, 决定退出制度同样能够提升器官捐献率。

3 研究2:不同捐献登记表设计形式对器官捐献率的影响

3.1 研究目的

为探寻更为经济简约且低成本的助推手段, 研究2从器官捐献登记表的设计层面出发, 借鉴世界各国器官捐献登记表的设计形式, 基于这些登记表设计中采用的行为经济学效应, 如反应模式、问题排列顺序等, 试图探索在“决定退出”或“决定参加”这两种默认捐献制度下更有效的器官捐献登记表设计架构。

3.2 研究方法

3.2.1 被试

在全国范围内, 通过网络招募大学生被试923名, 被试均未参加过先前的实验。为确保被试认真阅读题目和作答, 我们设计了一道核查问题, 要求不同实验条件下的被试均报告“在该地区的制度下, 人们是否会自动成为器官捐献者”。共224名被试(32.05%)回答错误, 认为其没有理解实验操作或没有认真作答, 不纳入下一步分析。筛选后被试共699人, 其中7人对器官捐献已有明确态度, 非本

研究考察对象。最终有效被试692人, 其中男性209人, 平均年龄21.29 ± 2.59岁。

3.2.2 研究设计和流程

问卷通过问卷星(www.wjx.cn)发放, 约5~10分钟完成, 被试首先填写知情同意书, 随后被随机分配至各任务条件, 问卷结束后被试可获得5元报酬。

问卷包括两部分。第一部分是器官捐献意愿问题, 采用被试间两因素(捐献制度、捐献登记形式)嵌套设计, 捐献登记形式因素嵌套在捐献制度因素内。其中, 捐献制度的两个水平为决定参加和决定退出。决定参加制度条件下包括5种版本操作的捐献登记形式:对照版、拒绝反应模式版(日本)、接受反应模式版(日本)、问题排列顺序版(美国德克萨斯州)和明确选项的内涵版(美国纽约州); 决定退出制度下包括3种版本操作的捐献登记形式:对照版、提供第三个选项版(塞浦路斯)和询问理由版(英国威尔士)。具体来说, 两种捐献制度中的对照版分别与研究1决定参加和决定退出条件相同, 其他各捐献登记表版本详见如下。

决定参加制度中, 日本不仅考虑了捐献部分器官的情况, 而且在登记表的设计中采用了拒绝反应模式, 被试未取消勾选的器官记录为被试愿意捐献的器官。该版本题目如下:
请在您 不想要捐献 的器官处, 取消勾选:
þ肾脏 þ肝脏 þ心脏 þ肺脏 þ胰腺 þ小肠 þ胰岛细胞 þ眼角膜

此外, 为了初步探究拒绝反应模式可能的效果, 我们对照日本的登记形式设计了“接受反应模式版本”用于对比, 被试勾选的器官记录为被试愿意捐献的器官。题目如下:

请勾选您 想要捐献 的器官:
□肾脏 □肝脏 □心脏 □肺脏 □胰腺 □小肠 □胰岛细胞 □眼角膜

美国德克萨斯州版本在登记表架构中操纵了问题排列顺序, 采用“登门槛”技术, 我们根据中国实际情况对该版本进行了改编, 要求被试依次在如下问题中做出是或否的回答:

(1)你是中国公民吗?

(2)你愿意捐助10元给白内障复明手术项目吗?

(3)你愿意捐助10元给中国器官移植发展基金会吗?

(4)你愿意参加器官捐献相关的志愿者活动吗?

(5)你愿意登记注册成为一个器官捐献者吗?

美国纽约州版本考虑了捐献的器官/组织的用途, 可以帮助决策者明确各选择的内涵, 其题目是在决定参加的对照版本基础上增加了一题:

我指定, 我捐献的器官和组织将用于____

a. 器官移植和科学研究 b. 仅供器官移植 c. 仅供科学研究

决定退出制度中, 塞浦路斯版本在注销捐献身份的表格中, 考虑了从器官捐献志愿者登记系统中删除姓名的因素, 因此, 我们在对照版本中增加了第三个选项:“我希望从器官捐献志愿者登记系统中删除我的名字”。

威尔士版本则在注销捐献身份的表格中考虑了注销者退出捐献系统的理由, 因此在对照版本的基础上, 增加一题, 询问了不想要捐献器官的原因。被试需要在下列给定的若干原因中进行单项选择:“离开本地”、“宗教原因”、“身体健康状况不适”、“我登记错了”、“个人意愿改变”、“家属不同意”、“不赞成本地区器官捐献制度”、“拒绝接受邮件”、“器官捐献注册数据问题”。

问卷的第二部分为人口统计学和器官捐献相关知识和经验等信息, 与研究1相同。

3.3 结果与讨论

各个版本中被试样本及捐献率的描述性统计结果见表2。单因素方差分析与卡方检验结果显示:各组被试在性别分布、年龄、信仰宗教人数、器官捐献知识得分分布上均无显著差异(ps > 0.10)。

表2   各制度下不同捐献登记设计形式条件中被试分布与捐献率统计表

实验条件 n 男性比例 年龄(M ± SD) 有宗教
信仰比例
器官捐献知识
正确率(M ± SD)
器官捐献
率(M ± SE)
捐献制度 登记表架构
决定参加 (平均) 460 30.21% 21.47 ± 2.63 7.83% 70.5% ± 10.6% 72.83% ± 4.58%
对照版本 92 31.52% 21.80 ± 2.63 9.78% 70.1% ± 10.6% 69.57% ± 4.78%
问题排列顺序 81 37.03% 21.15 ± 2.80 7.41% 72.2% ± 11.1% 60.49% ± 5.43%
明确选项内涵 126 26.19% 21.52 ± 2.86 7.94% 69.7% ± 11.6% 76.98% ± 3.75%
拒绝反应模式 69 36.23% 20.95 ± 2.01 1.44% 69.6% ± 9.2% 85.51% ± 4.24%
接受反应模式 92 23.91% 21.73 ± 2.49 10.87% 71.1% ± 9.5% 71.74% ± 4.69%
决定退出 (平均) 232 29.31% 20.96 ± 2.50 8.19% 70.6% ± 9.4% 81.90% ± 4.25%
对照版本 104 34.62% 21.17 ± 2.50 11.54% 69.9% ± 10.3% 76.92% ± 4.13%
提供第三个选项 63 25.39% 21.19 ± 2.40 7.93% 70.1% ± 8.6% 80.00% ± 4.78%
询问理由 65 24.61% 20.38 ± 2.54 3.10% 72.4% ± 8.6% 87.93% ± 3.84%

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我们以被试是否捐献器官为因变量分别建立了两个逻辑回归模型。为考察两种默认捐献制度效应的差异, 模型1以默认捐献制度为自变量, 控制了性别、年龄与宗教信仰。回归结果发现(表2), 决定退出制度组的平均捐献率高于决定参加制度组的平均捐献率(z = 2.58, OR = 3.33, p = 0.01, Cox & Snell R2 = 0.051, Nagelkerke R2 = 0.076), 再次验证了研究1的结果, 说明决定退出制度在中国的器官捐献率优于决定参加制度。为探究两种制度下各种登记捐献形式的优劣, 模型2以各种登记捐献形式为自变量, 并控制了性别、年龄与宗教信仰。结果发现拒绝反应模式中的器官捐献率显著高于接受反应模式版本(z = 2.06, OR = 2.29, p = 0.048)、问题排列顺序版本(z = 3.16, OR = 3.68, p = 0.002)和对照版本(z = 2.14, OR = 2.43, p = 0.033), 但与决定退出制度下各版本的捐献率没有显著差异(ps > 0.10)。此外, 决定退出制度下各版本的捐献率无显著差异(ps > 0.10); 决定参加制度下, 明确选项内涵版本捐献率显著高于问题排列顺序版本(z = 2.43, OR = 2.15, p = 0.015), 与对照版本(z = 1.87, OR = 2.35, p = 0.061), 与决定参加制度下其他各版本均无显著差异(ps > 0.10), 但是仍低于拒绝反应模式。这说明, 即使在决定参加制度下, 拒绝反应模式也可以明显提升器官捐献率, 其效果不弱于决定退出制度, 但决定退出制度内各个版本无明显的优劣之分。

为进一步明晰拒绝反应模式的作用, 我们设计了接受反应模式版本进行对比。比较两种反应模式可见:除了器官捐献率外, 在拒绝反应模式下(5.91 ± 0.31), 被试平均捐献器官的数量也高于接受反应模式(3.85 ± 0.36), t (100) = 4.00, p < 0.001, Cohen’s d = 0.79。这说明, 在决定参加制度下, 拒绝反应模式在提升捐献登记率和增加捐献器官数量两方面均优于接受反应模式。

综上, 研究2进一步验证了研究1的发现, 决定退出制度在中国文化背景下的器官捐献率高于目前采用的决定参加制度, 且决定退出制度下不同国家/地区版本的器官捐献率无显著差异。更重要的是, 研究2发现, 在决定参加制度中, 拒绝反应模式版本的器官捐献率与决定退出制度下的各国家/地区的版本不相上下, 且其捐献率明显高于同一制度内其他国家/地区的版本。考虑到变更捐献制度可能具有巨大的社会成本, 若沿用中国现有的“决定参加”制度体系, 应采用捐献率更高的拒绝反应模式。

4 研究3:反应模式及相关因素对潜在捐献者捐献器官数量的影响

4.1 研究目的

研究1和研究2意欲解决的问题是, 如何“助推”人们做出志愿捐献器官的抉择?当人们同意捐献器官之后, 接踵而来的问题是, 如何提高这些潜在捐献者愿意捐献器官的数量?鉴于拒绝反应模式在改变人们器官捐献意愿上的潜在优势, 研究3试图从提高个体捐献器官数量的角度, 深入考察拒绝反应模式及其可能的相关因素的作用。中国传统有“注重遗容”的文化观念, 被试在考虑是否捐献某个具体器官时, 备选捐献器官对捐献者外观的影响程度以及器官相应的呈现顺序可能会影响人们的决策。因此, 研究3同时考察了和拒绝反应模式相关的两个因素的作用:备选捐献器官对捐献者外观的影响程度和备选捐献器官的呈现顺序。

4.2 研究方法

4.2.1 被试

通过网络招募全国大学生被试218名, 被试均未参加过先前的实验。为确保被试认真作答, 我们设计了3道核查问题, 被试若回答错误任意一题, 系统直接视其为无效问卷。由于本研究的研究对象为选择仅愿意捐献部分器官的被试, 因此对于选择愿意捐献全部器官与不愿意捐献器官的被试, 同样不进行记录。其中, 16人已登记成为器官捐献志愿者或自己/亲友有器官捐献经历/需求, 非本研究考察对象, 未纳入后续分析。最后有效被试202人, 其中男性47人, 平均年龄21.49 ± 2.45岁。

4.2.2 研究设计与流程

为考察在决定参加制度下, 所捐器官对捐献者外观的影响程度, 我们进行了预实验。预实验通过问卷星(www.wjx.cn)共招募54名大学生被试, 选取了16个中国或世界卫生组织公布的可以用于器官移植的器官/组织。预实验要求被试就捐献16个器官/组织对外观影响的程度进行6点评定, 分数越高表示其对外观影响越大。根据评定结果, 这些器官/组织按对外观影响大小降序排列分别为:眼睛(5.52)、皮肤(4.91)、骨骼(4.89)、角膜(4.46)、肌腱(4.35)、心脏(4.24)、静脉(4.04)、肺脏(4.00)、脾脏(3.98)、肾脏(3.89)、肝脏(3.81)、胸腺(3.72)、心脏瓣膜(3.69)、胰腺(3.56)、小肠(3.44)、骨髓(2.98)。因此, 我们将16个器官分为两组:高影响外观的器官包括肉眼可见的器官(眼睛、皮肤、角膜)与运动系统的器官(骨骼、肌腱), 其余11个器官或组织定义为低影响外观的器官。配对样本t检验显示, 高影响外观的器官在外观评分均高于低影响外观的器官, M(高影响外观的器官) = 4.82, M(低影响外观的器官) = 3.76, t(53) = 6.30, p < 0.001, Cohen’s d = 0.63, 这说明该分组方式有效。

正式实验通过问卷星(www.wjx.cn)发放问卷, 约需5~10分钟完成, 被试首先填写知情同意书, 随后被随机划分到各实验条件组。所有实验任务结束后可获得5元报酬。

问卷包括两部分。第一部分是器官捐献意愿问题, 为考察反应模式效应, 采用两因素被试间实验设计, 自变量为反应模式(接受、拒绝)和器官呈现顺序(对外观影响升序呈现、对外观影响降序呈现)。各条件下, 被试均需要在“愿意捐献全部可用器官”、“愿意捐献部分可用器官”与“不愿意捐献器官”中做出三择一的选择。被试若选择了“愿意捐献部分可用器官”, 则呈现备选器官以供被试选择, 否则直接自动结束问卷, 且不进行记录。反应模式的题目同研究2:拒绝反应模式组被试取消勾选不愿意捐献的器官, 接受反应模式组被试勾选愿意捐献的器官。器官呈现顺序按照预实验评定结果进行排序, 升序条件下16种器官中骨髓排在首位, 降序条件下眼睛排在首位。

问卷的第二部分为人口统计学和器官捐献相关知识与经验等信息, 与研究1、研究2相同。

4.3 结果与讨论

各实验条件下被试样本描述性统计结果见表3, 单因素方差分析与卡方检验结果显示:各组被试在性别分布、年龄、信仰宗教人数、器官捐献知识得分分布上均无显著差异(ps > 0.10)。

表3   不同反应模式和呈现顺序条件下被试分布统计表

实验条件 n 男性比例 年龄(M ± SD) 有宗教信仰比例 器官捐献知识正确率(M ± SD)
反应模式 呈现顺序
拒绝 升序 53 26.42% 21.64 ± 2.40 13.20% 70.0% ± 10.1%
降序 47 17.02% 21.30 ± 2.29 8.51% 69.4% ± 9.1%
接受 升序 46 23.91% 21.52 ± 2.30 6.52% 69.7% ± 10.1%
降序 56 25.00% 21.48 ± 2.78 1.79% 71.7% ± 10.6%

新窗口打开| 下载CSV


为考察反应模式对器官捐献数量的作用, 我们以被试志愿捐献的器官数量占所有可捐器官的比例为因变量(图1a), 控制了性别、宗教信仰与年龄的因素, 进行了2(反应模式:接受、拒绝)×2(排列顺序:升序、降序)方差分析。结果显示, 拒绝反应模式在提升捐献器官数量上优于接受反应模式, F(1,195) = 40.7, p < 0.001, ηp2 = 0.163。这重复了研究2的发现, 但排列顺序的主效应不显著, F(1,195) = 0.08, p = 0.78。反应模式与排列顺序交互作用显著, F(1,195) = 4.49, p = 0.035, ηp2 = 0.023, 但简单效应分析未发现不同反应下排列顺序的显著作用(ps > 0.10)。

图1

图1   研究3中被试器官捐献比例(M ± 1 SE)。(a)在不同反应模式与不同排列顺序下捐献器官数量的比例; (b)被试对于两类不同程度影响外观的器官在不同反应模式与排列顺序下捐献器官数量的比例。


考虑到器官排列顺序可能仅影响被试对部分器官(如高或低影响外观)的捐献意愿, 我们以是否捐献单个器官为因变量建立了混合效应的逻辑回归方程。其中, 反应模式、排列顺序和捐献器官对捐献者外观的影响程度为自变量, 被试为随机变量, 并控制了被试的性别、宗教信仰和年龄。结果同样发现, 拒绝反应模式可较大程度提高对单个器官的捐献比例, 从平均46.91%提高至平均70.98% (z = 3.52, OR = 3.09, p < 0.001)。反应模式、排列顺序与捐献器官对捐献者外观的影响程度三阶交互作用显著(z = 2.17, OR = 2.45, p = 0.03)。简单效应分析发现:在拒绝反应模式下, 低影响外观的器官在升序排列时其捐献率更高(z = -1.86, p = 0.063, Cohen’s d = 0.63); 在接受反应模式下, 低影响外观的器官在降序排列时的捐献率更高(z = 1.70, p = 0.089, Cohen’s d = 0.57), 但两种反应模式下, 高影响外观的器官均无显著的排列顺序影响(ps > 0.10)。该结果说明, 不同反应模式下, 低影响外观器官的捐献率均受到其排列顺序的影响:拒绝反应模式下将低影响外观器官排列在其他器官前, 可将该器官捐献率提高至63.46%。

综上, 研究3再次说明, 从器官捐献数量上看, 使用拒绝反应模式的捐献登记表能够提升被试愿意捐献器官的数量和对单个器官的捐献率, 且呈现器官的排列顺序影响了低影响外观的器官的捐献数量。因此, 为了有效提高捐献者志愿捐献的器官数量, 可以在器官捐献登记表中采用拒绝反应模式, 并按对外观影响大小升序排列捐献器官种类。

5 总讨论

针对中国器官捐献的窘况, 我们认为, 提高中国器官捐献的途径一是提高我国民众的志愿器官捐献登记率, 二是增加志愿捐献者的登记捐献器官数量。围绕这两条途径, 本研究从器官捐献制度和器官捐献登记表设计层面着手助推器官捐献行为。研究1从器官捐献制度层面着手, 对比了决定退出和决定参加制度下的器官捐献率, 发现决定退出制度下的器官捐献率显著高于决定参加制度; 研究2从器官捐献登记表设计层面着手, 对不同国家/地区捐献登记形式进行比较研究, 发现在决定参加制度中, 采用拒绝反应模式登记形式的器官捐献率最高, 甚至与决定退出制度下的各国家/地区版本相比不相上下; 研究3聚焦于提高器官捐献数量, 发现使用拒绝反应模式的捐献登记表能够提升器官捐献率、增加愿意捐献的器官数量; 且低影响外观器官的捐献率在拒绝反应模式下以升序排列时最高。

5.1 默认选项效应对提高器官捐献率的影响

默认选项效应是行为经济学最成功的助推手段之一, 器官捐献领域在国际上主要应用该效应推广了决定退出制度, 代替传统的决定参加器官捐献制度。本研究的研究1和研究2共同发现, 与大部分国际研究结果一致, 在中国文化背景中, 决定退出制度下的器官捐献率优于决定参加制度。其中, 研究1直接比较了两种默认捐献制度, 发现决定退出制度下的器官捐献率(83.61%)比决定参加制度下(68.33%)高出近15%。研究2直接对比了两种制度下不同国家/地区器官捐献登记形式, 发现决定退出制度下的平均器官捐献率(81.90%)依然比决定参加制度(72.83%)下高9%。这说明决定退出制度在中国文化背景下对提升器官捐献率的效果具有一定的稳健性。但是, 与国际上报告的数据相比, 决定退出制度在本研究中对器官捐献的提高率偏低。一项整合了22个国家10年间器官捐献率的研究曾报告, 在控制了其他因素后, 决定退出制度比决定参加制度下的器官捐献率平均约高25%~30% (Abadie & Gay, 2006), 甚至有研究报告决定退出制度(82%)下的器官捐献率是决定参加制度(42%)的2倍(Johnson & Goldstein, 2003)。这可能是由于本研究样本是大学生, 由于受教育程度偏高、对器官捐献的态度较为积极, 大学生群体在现行决定参加制度下的基础捐献率可能存在高原效应。因此, 决定退出制度在中国的适用性, 尚需在更有代表性的中国民众样本中进行进一步检验。

5.2 器官捐献登记表的架构设计对提高器官捐献率的影响

除宏观层面、较大社会成本的捐献制度设计外, 本研究的独特之处在于, 我们从微观层面的捐献登记表的架构设计, 探索了提升器官捐献率的一些有效方法。首先, 我们发现了拒绝反应模式在器官捐献表设计中的突出作用。消费决策等领域已经报告了反应模式对人们决策行为的作用, 如采用接受或拒绝反应模式会影响甚至改变人们选择产品的种类(Dhar & Wertenbroch, 2000)和数量(Levin, Schreiber, Lauriola, & Gaeth, 2002)。但在器官捐献领域, 除日本已在器官捐献登记表的设计中使用了拒绝反应模式外, 尚未见研究直接探索其对器官捐献效果的直接作用。本研究2和研究3共同发现, 器官捐献登记表的架构设计中采用拒绝反应模式的设计, 可以有效提升人群器官捐献率和人均捐献器官数量。值得指出的是, 拒绝反应模式用于决定参加制度时, 在提升器官捐献率上, 其效果与广为称道的决定退出制度不相上下:研究2中拒绝反应模式下的捐献率85.51%, 而在决定退出制度下, 各版本捐献率的范围是76.92%~87.93%; 在器官捐献数量上, 拒绝反应模式下的器官捐献数量(5.91个)比传统的接受反应模式下(3.85个)增加了约60%。这些结果说明, 作为一种简单易操作的助推方式, 反应模式可能在提升器官捐献上具有较大的优势。

在器官捐献登记表的架构设计层面, 本研究还发现了捐献器官排列顺序的重要作用。在健康领域的助推研究中, 顺序效应的优势已初见成果:如放置在菜单顶部和底部的食品选择比例比放置在中部多20% (Dayan & Bar-Hillel, 2011)。在器官捐献领域中亦有部分地区借助了顺序效应:如美国德克萨斯州在驾照申请登记中利用了顺序效应加入了志愿捐献器官的选项, 但并未涉及到捐献器官的排列顺序。考虑到干扰人们捐献器官的潜在原因之一是所捐献器官对捐献者遗容外观的影响, 且该因素在中国传统文化情境中的作用可能更大, 本研究率先将捐献器官排列顺序引入到器官捐献登记表的设计中。我们发现, 如果将捐献器官按照对外观的影响程度进行降序或升序排列, 排列顺序对低影响外观的器官影响更大:当其排在前面时, 捐献率更高; 但对高影响外观器官的影响较小。这一结果的可能原因在于, 人们面对低影响外观器官时投入的意志努力相对少, 更容易受到选项架构的影响, 反之, 在面对高影响外观的器官时, 会投入更多的意志努力, 更不容易受选项架构的影响。这与有关金钱捐献行为中的发现(Goswami & Urminsky, 2016)一致:当默认选项为捐较小数额($0.5)时, 个体对默认选项的选择显著高于控制组; 而当默认选项为捐较大数额($3)时, 并没有发现默认选项的优势。

5.3 研究不足与展望

本研究尚存在一些不足。首先, 本研究为匿名方式, 且并非以器官捐献相关组织名义收集数据, 因此被试的主观报告仅代表其对捐献器官登记的预期。尽管大多数人对器官捐献持积极态度, 如55%的欧洲人表示愿意在死后捐献其器官(Demir & Kumkale, 2013), 考虑到社会赞许性的可能作用, 该意愿与其实际捐献行为可能存在差异。但是, 鉴于器官捐献研究先天受限于科研伦理, 难以在不违背伦理的前提下考察真实的捐献行为——实验操纵可能会对被试的器官捐献意愿产生诱导性, 导致被试的捐献意愿非真实意图, 违背了实验伦理(Harel, Kogut, Pinchas, & Slovic, 2017), 未来研究者与政策制定人员在使用器官捐献意愿作为实际捐献行为的参考指标时, 务必考虑这一差异的存在。其次, 本研究主要以在校大学生为样本, 大学生更有可能通过学校教育、网络媒体等多种途径接触器官捐献知识, 以致大学生被试报告的器官捐献登记会偏高, 出现取样偏差。因此, 未来研究可考虑使用多样化被试群体全面考察民众的器官捐献意愿。

此外, 未来研究中尚需要考虑以下几方面因素对器官捐献的影响。首先, 中国器官捐献系统所面临的一个巨大挑战是如何提升亲属同意率(Luo, Xie, Luo, & Ouyang, 2016), 本研究尚未涉足该领域, 未来可考虑从提高家属同意率入手解决中国棘手的器官短缺问题。其次, 本研究主要借鉴默认选项效应和选项设计效应对器官捐献行为进行探索, 未来研究可继续发挥助推的优势, 将更多的心理学效应运用在器官捐献等利国利民的实践中, 例如眼睛效应(watching eyes effect)、从众效应(conformity effect)等。

6 结论

本研究以中国在校大学生为样本, 通过3个调查研究考察了默认选项效应及登记反应模式对提升我国民众器官捐献意愿的影响。研究发现, 中国文化背景中决定退出制度下的器官捐献率优于决定参加制度; 在决定参加制度中, 采用拒绝反应模式的器官捐献登记表在提升器官捐献率和器官捐献数量上, 均优于该制度下其他设计形式, 且效果等同于决定退出制度; 此外, 在拒绝反应模式下, 将低影响外观的器官以升序排列时, 器官捐献率达到最高。因此, 中国政府、红十字会等器官捐献相关机构未来可考虑采取如下措施提高中国的志愿器官捐献水平:摒弃中国现行的“决定参加”器官捐献制度, 转而采用“决定退出”的器官捐献制度; 或:不放弃中国现行的“决定参加”器官捐献制度, 但在器官捐献登记表中采用拒绝反应模式, 并按对外观影响大小升序排列捐献器官种类。

致谢:饶俪琳对研究设计提出宝贵建议, 杜志鸿提供了重要参考文献, 蔡晓红、岳灵紫及课题组成员和其他人员在问卷收集中予以帮助, 特此致谢。

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No abstract is available for this item.

Global Observatory on Donation and Transplantation. ( 2014).

Retrieved May 4, 2018, from

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Goswami I.., & Urminsky , O. ( 2016).

When should the ask be a nudge? The effect of default amounts on charitable donations

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How does setting a donation option as the default in a charitable appeal affect people’s decisions? In eight studies, comprising 11,508 participants making 2,42

Harel I., Kogut T., Pinchas M., & Slovic P . ( 2017).

Effect of media presentations on willingness to commit to organ donation

.Proceedings of the National Academy of Sciences, 114(20),51595164.

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We examine how presentations of organ donation cases in the media may affect people's willingness to sign organ donation commitment cards, donate the organs of a deceased relative, support the transition to an "opt-out" policy, or donate a kidney while alive. We found that providing identifying information about the prospective recipient (whose life was saved by the donation) increased the participants' willingness to commit to organ donation themselves, donate the organs of a deceased relative, or support a transition to an "opt-out" policy. Conversely, identifying the deceased donor tended to induce thoughts of death rather than about saving lives, resulting in fewer participants willing to donate organs or support measures that facilitated organ donation. A study of online news revealed that identification of the donor is significantly more common than identification of the recipient in the coverage of organ donation cases-with possibly adverse effects on the incidence of organ donations.

Huang B. Z., Xu F. M., Wang L., Ma X. Y., & Wu X. L . ( 2011).

Default effect in behavioral decision making

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[ 黄宝珍, 徐富明, 王岚, 马向阳, 吴修良 . ( 2011).

行为决策中的默认效应

心理科学进展,19(11),16751683.]

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Huang J., Mao Y., & Millis J. M . ( 2008).

Government policy and organ transplantation in China

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URL     PMID:18930537      [本文引用: 1]

Author information: (1)Vice-Minister of Health, Beijing, China.

Huang J., Millis J. M., Mao Y., Millis M. A., Sang X., & Zhong S . ( 2012).

A pilot programme of organ donation after cardiac death in China

.The Lancet, 379(9818),862865.

URL     PMID:22078722      [本文引用: 1]

Abstract China's aims are to develop an ethical and sustainable organ transplantation system for the Chinese people and to be accepted as a responsible member of the international transplantation community. In 2007, China implemented the Regulation on Human Organ Transplantation, which was the first step towards the establishment of a voluntary organ donation system. Although progress has been made, several ethical and legal issues associated with transplantation in China remain, including the use of organs from executed prisoners, organ scarcity, the illegal organ trade, and transplantation tourism. In this Health Policy article we outline the standards used to define cardiac death in China and a legal and procedural framework for an organ donation system based on voluntary donation after cardiac death that adheres to both China's social and cultural principles and international transplantation standards. Copyright 01020008 2012 Elsevier Ltd. All rights reserved.

Jiang C.-M., Zheng R., Zhou Y., Liang Z.-Y., Rao L.-L., Sun Y., … Li S . ( 2013).

Effect of 45-day simulated microgravity on the evaluation of orally reported emergencies

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URL     PMID:23789793      [本文引用: 1]

Accurate evaluation of emergencies is a critical concern in long-duration space flights. Accordingly, we studied the effect of 45 days of - 6 head-down bed rest - a model that simulates the conditions in microgravity environments - on the evaluation of orally reported emergencies. Sixteen male participants listened to corresponding emergency scenarios and assessed the severity of these situations eight times before, during and after bed rest. The results revealed a ' recency effect': compared with emergency descriptions in the order of serious to mild, those framed in the reverse order were judged to be more serious. However, the severity ratings did not vary with time spent in the simulated microgravity environment. These findings are similar to those observed in a regular environment on Earth, indicating that the design principles of information presentation for situations on Earth may also be extended to designs intended for outer space.A recency effect was found in the evaluation of orally reported emergencies under simulated microgravity conditions. The design principles of information presentation for situations on Earth may also be extended to designs intended for outer space.

Johnson E. J., Bellman S., & Lohse G. L . ( 2002).

Defaults,framing and privacy: Why opting in-opting out

.Marketing Letters, 13(1),515.

URL     [本文引用: 1]

Differences in opt-in and opt-out responses are an important element of the current public debate concerning on-line privacy and more generally for permission marketing. We explored the issue empirically. Using two on-line experiments we show that the default has a major role in determining revealed preferences for further contact with a Web site. We then explore the origins of these differences showing that both framing and defaults have separate and additive effects in affecting the construction of preferences.

Johnson E.J., & Goldstein , D. ( 2003).

Do defaults save lives?

Science,302, 13381339.

[本文引用: 5]

Kahneman D.., & Tversky , A. ( 1979).

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Kaushik J.., . (2009).

Organ transplant and presumed consent: Towards an "opting out" system

.Indian Journal of Medical Ethics, 6(3),149152.

URL     PMID:19653591      [本文引用: 1]

This paper examines the "opt out" system of organ donation wherein the State permits removal of tissue and organs posthumously unless an express objection is made by the person prior to the death. This paper examines the need for "presumed consent" and the jurisprudential arguments in support of it. The social contract theory and the sociological approach based on the principle of "common good" support this system. However, the ethical concerns raised while implementing such a system are debatable. It is for societies to evaluate the situation and make a choice between "ethics"and "common good". The answer may not be obvious in a country like India where religion may supersede the question of life and death. The paper critically assesses both the issues, and concludes that presumed consent may be a viable method of addressing the organ shortage in India. However, we need public discourse and public awareness to change people's attitude to this concept.

Levin I. P., Schreiber J., Lauriola M., & Gaeth G. J . ( 2002).

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Li D., Hawley Z., & Schnier K . ( 2013).

Increasing organ donation via changes in the default choice or allocation rule

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URL     PMID:24135615      [本文引用: 1]

This research utilizes a laboratory experiment to evaluate the effectiveness of alternative public policies targeted at increasing the rate of deceased donor organ donation. The experiment includes treatments across different default choices and organ allocation rules inspired by the donor registration systems applied in different countries. Our results indicate that the opt-out with priority rule system generates the largest increase in organ donation relative to an opt-in only program. However, sizeable gains are achievable using either a priority rule or opt-out program separately, with the opt-out rule generating approximately 80% of the benefits achieved under a priority rule program.

Li S. ( 2016).

Neither "carrot" nor "stick": A new shortcut to nudge social development

.Management Insights, 15, 92-96.

[本文引用: 2]

[ 李纾 . ( 2016).

既非“胡萝卜”也非“大棒”: 助推社会发展的一条新捷径

管理视野, 15, 92-96.]

[本文引用: 2]

Li, W J., Zheng Q. Q., & Yao N. L . ( 2009).

The impact of information presented order on fairness judgment forming

. Chinese Journal of Applied Psychology,15(2), 112-119.

URL     [本文引用: 1]

在公平启发理论的基础上,以 130名大学生为被试采用实验室实验探讨了信息呈现顺序对公平判断形成的影响。结果表明:(1)信息呈现顺序能够影响人们的公平判断——当结果适宜性信息 更早获得时,结果公平对公平判断的影响要大于结果适宜性信息较晚呈现时的影响;(2)公平形式偏好对公平判断的信息效应具有调节作用,即当高偏好信息先于 低偏好信息出现时,公平判断的顺序效应会得到加强;而在低偏好信息先于高偏好信息出现的情况下,公平判断的顺序效应会被减弱。

[ 李文静, 郑全全, 姚乃琳 . ( 2009).

信息呈现顺序对公平判断形成的影响

应用心理学, 15(2),112-119.]

URL     [本文引用: 1]

在公平启发理论的基础上,以 130名大学生为被试采用实验室实验探讨了信息呈现顺序对公平判断形成的影响。结果表明:(1)信息呈现顺序能够影响人们的公平判断——当结果适宜性信息 更早获得时,结果公平对公平判断的影响要大于结果适宜性信息较晚呈现时的影响;(2)公平形式偏好对公平判断的信息效应具有调节作用,即当高偏好信息先于 低偏好信息出现时,公平判断的顺序效应会得到加强;而在低偏好信息先于高偏好信息出现的情况下,公平判断的顺序效应会被减弱。

Luo A. J., Xie W. Z., Luo J. J., & Ouyang W . ( 2016).

Public perception of cadaver organ donation in Hunan province, China

Transplantation Proceedings,48(8), 2571-2576

URL     PMID:27788783      [本文引用: 1]

Public knowledge of organ donation is poor, and based on television, movies and communication networks;Individuals with increased knowledge of organ donation exhibited more positive attitudes, and such respondents showed greater willingness to donate their own organs.Positive attitudes toward donation displayed in the surveys were not matched by actual organ donation.

Mourali M.., &Nagpal A. , ( 2013).

The powerful select, the powerless reject: Power's influence in decision strategies

Journal of Business Research, 66(7), 874-880.

URL     [本文引用: 1]

This research examines the influence of power on consumer decision strategies. It proposes that high power directs consumers' attention to options' positive features, making choosing a more preferred strategy than rejecting, whereas low power shifts consumers' focus to negative features, making rejecting a more preferred strategy than choosing. Two studies using different manipulations of power provide consistent support for this effect. The results also indicate that consumers in a state of high power are more satisfied with their choices when they adopt a choosing strategy than when they adopt a rejecting strategy, whereas the opposite is true for consumers in a state of low power. In addition, study 2 shows that the previous effects are reduced when consumers' sense of responsibility is made salient.

National Donor Designation Report Card 2014. Retrieved October 3,2017, from

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Payne J. W., Bettman J. R., & Johnson E. J . ( 1992).

Behavioral decision research: A constructive processing perspective

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The highly contingent nature of decision behavior both poses problems (costs) and creates opportunities (benefits) for decision researchers. That decision processes (DPs) are not invariant across task environments complicates the search for a small set of underlying principles. Questions about the conditions under which different types of information and different DPs are likely to be used can yield such generalizations as (1) the effects of task complexity on decision-strategy use, (2) the importance of gain vs loss in both risky and riskless preference, and (3) the prevalence of the anchoring and adjustment process in judgment. The constructive and contingent nature of DPs has implications for integrating decision research with other areas of psychology and applications such as the practice of decision analysis, the design of information environments, and the measurement of values. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Pliner P., Hart H., Kohl J., & Saari D . ( 1974).

Compliance without pressure: Some further data on the foot-in-the-door technique

.Journal of Experimental Social Psychology, 10(1), 17-22.

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A replication of the Freedman and Fraser (1966) “foot-in-the-door” technique was attempted in which subjects were exposed to one of two prior requests and were then asked to comply with a larger request. The results showed that subjects receiving prior requests complied with the larger request significantly more often than did control subjects. The mechanism by which the technique operates was discussed.

Policastro P., Smith Z., & Chapman G . ( 2017).

Put the healthy item first: Order of ingredient listing influences consumer selection

Journal of Health Psychology, 22(7), 853-863.

URL     PMID:26672109      [本文引用: 1]

Abstract This study examined effects of an order form intervention on choice of healthy ingredients among college students ordering submarine sandwiches (subs). Over eight weekly sub-nights, college students submitted 9765 orders. The order form format was manipulated in one condition making the healthier selections more salient. Main outcome measures were selection of ingredients. Multi-level logistic regression, chi square, and analysis of variance were used to examine the effect of experimental conditions on selection of ingredients. The health-salient form increased selection of healthier and decreased selection of unhealthy ingredients. The manipulation increased fiber, decreased sodium, but did not impact calorie/fat levels of the subs served. The Author(s) 2015.

Red Cross Society of China Organ Donation Administrative Center. ( 2018). Retrieved May 5,2018, from

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[ 中国红十字会中国人体器官捐献管理中心. ( 2018. . 2018- 05-05,取自 ]

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Shafir E. ( 1993).

Choosing versus rejecting: Why some options are both better and worse than others

Memory & Cognition, 21, 546-556.

URL     PMID:8350746     

A previously unobserved pattern of choice behavior is predicted and corroborated. In line with the principle of compatibility, according to which the weighting of inputs is enhanced by their compatibility with output, the positive and negative dimensions of options (their pros and cons) are expected to loom larger when one is choosing and when one is rejecting, respectively. Subjects are presented with pairs of options, one of which—the enriched option—has more positive as well as more negative dimensions than does the other, impoverished , option. Because positive dimensions are weighted more heavily in choosing than in rejecting, and negative dimensions are weighted more heavily in rejecting than in choosing, the enriched option tends to be chosen and rejected relatively more often than the impoverished option. These findings are extended to nonbinary decision problems, and their implications for the rational theory of choice and for everyday decisions are discussed.

Su Z. ( 2017 -04-05).

Make a connection for organ donation - donation coordinator's sweet and sour (found beside).

People's Daily, 2017-04-05(08).

[本文引用: 1]

[ 孙振 . ( 2017-04-05).

为器官捐献牵线搭桥——一位捐献协调员的酸甜苦辣(发现身边)

. 人民日报, 2017-04-05(08).]

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Tang H.L., &Liu C. , ( 2004).

Some behavioral and functional neuroimaging studies on analogical reasoning

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类比推理是不同于演绎,也不同于归纳的一种独立的推理形式.作为人类认知发展的中心能力之一,类比推理已逐渐成为当代认知研究的一个活跃领域.研究表明类比推理不仅受顺序、因果结构、上下文连贯性等项目特征的影响,并且与加工速度、工作记忆等其它认知能力有密切关系.有关类比推理的神经影像研究则主要发现大脑左半球前部和后部区域的参与,似可进一步从脑生理水平表明类比推理与工作记忆存在密切关系.

[ 唐慧琳, 刘昌 . ( 2004).

类比推理的影响因素及脑生理基础研究

心理科学进展 , 12( 2), 193‒200.]

URL     [本文引用: 1]

类比推理是不同于演绎,也不同于归纳的一种独立的推理形式.作为人类认知发展的中心能力之一,类比推理已逐渐成为当代认知研究的一个活跃领域.研究表明类比推理不仅受顺序、因果结构、上下文连贯性等项目特征的影响,并且与加工速度、工作记忆等其它认知能力有密切关系.有关类比推理的神经影像研究则主要发现大脑左半球前部和后部区域的参与,似可进一步从脑生理水平表明类比推理与工作记忆存在密切关系.

The Central People’s Government of the People’s Republic of China. ( 2007).

Retrieved October 17, 2017, from

2007).

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[ 中华人民共和国中央人民政府. ( 2007.

2017-10-17, 取自民共和国中央人民]

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van Dalen, H. P., &Henkens K. . ( 2014).

Comparing the effects of defaults in organ donation systems

. Social Science & Medicine, 106, 137-142.

URL     PMID:24561775      [本文引用: 4]

The ability of patients in many parts of the world to benefit from transplantation is limited by growing shortages of transplantable organs. The choice architecture of donation systems is said to play a pivotal role in explaining this gap. In this paper we examine the question how different defaults affect the decision to register as organ donor. Three defaults in organ donation systems are compared: mandated choice, presumed consent and explicit consent. Hypothetical choices from a national survey of 2069 respondents in May 2011 in the Netherlands – a country with an explicit consent system – suggests that mandated choice and presumed consent are more effective at generating registered donors than explicit consent.

, , Wang L., &Zhang X.P, . ( 2010).

Chinese public attitudes towards organ donation and influencing factors

Nursing Journal of Chinese People’s Liberation Army, 27(13), 968-971.

URL     [本文引用: 1]

目的了解我国公民对器官捐献态度的现状及其影响因素。方法检索中国生物医学文摘数据库CBMdisc(1978—2009年)、维普资讯中文科技期刊数据库(1989—2010年)、中国期刊全文数据库CNKI(1994—2009年)中关于器官捐献态度的调查性论文,同时筛检纳入论文的参考文献,并对检索收集的文献进行信息提取和分析。结果有关调查我国公民对器官捐献态度的研究不多,本研究共纳入9篇论文。9篇论文中调查对象以大学生、医护人员居多。各调查结果中公民赞成遗体器官捐献的有40%~70%,赞成活体器官捐献的有60%~80%。影响器官捐献的主要因素有对器官捐献知识和意义的认知程度、伦理道德、人生价值观、法律法规建设、器官捐献分配体系建设、社会支持力度、传统观念、宗教信仰和封建习俗、家庭利益及个人心理因素等。结论切实了解我国公民对器官捐献的真实态度及想法,可为器官移植和器官捐献事业的推进提供参考依据,有关部门应加大提高公民自愿捐献器官意识的力度,加快建设中国的器官捐献体系。

, 张晓萍 . ( 2010).

我国公民对器官捐献的态度及其影响因素

解放军护理杂志,27( 13),968‒971.]

URL     [本文引用: 1]

目的了解我国公民对器官捐献态度的现状及其影响因素。方法检索中国生物医学文摘数据库CBMdisc(1978—2009年)、维普资讯中文科技期刊数据库(1989—2010年)、中国期刊全文数据库CNKI(1994—2009年)中关于器官捐献态度的调查性论文,同时筛检纳入论文的参考文献,并对检索收集的文献进行信息提取和分析。结果有关调查我国公民对器官捐献态度的研究不多,本研究共纳入9篇论文。9篇论文中调查对象以大学生、医护人员居多。各调查结果中公民赞成遗体器官捐献的有40%~70%,赞成活体器官捐献的有60%~80%。影响器官捐献的主要因素有对器官捐献知识和意义的认知程度、伦理道德、人生价值观、法律法规建设、器官捐献分配体系建设、社会支持力度、传统观念、宗教信仰和封建习俗、家庭利益及个人心理因素等。结论切实了解我国公民对器官捐献的真实态度及想法,可为器官移植和器官捐献事业的推进提供参考依据,有关部门应加大提高公民自愿捐献器官意识的力度,加快建设中国的器官捐献体系。

Wu Y.M., & Zhu, J. Y . ( 2011).

Preliminary discussion on organ donation and sharing in China (2): Soft presumed consent

Chinese Journal of Transplantation (Electronic Version),, 5(1), 1-4.

URL     [本文引用: 1]

中国人均国民生产总值和人均医疗卫生投资较低,预示了在中国建立器官捐献系统较发达国家将会更加困难." 弹性假定同意"是经过多年多国实践检验的、能快速增加器官捐献率的知情同意法则,它既符合WHO器官捐献原则,在尊重供体捐献意愿的前提下,充分尊重家属 的知情同意权,同时也尊重不愿或不能捐献器官人群的人权,其经济易行的优点更加符合中国作为发展中国家的现实.心死亡器官捐献、高效率的器官捐献登记系 统、帮扶政策三者的有机结合,似乎更加符合中国现阶段国情,是中国器官捐献可持续发展需要深入研究和探讨的问题.

[ 吴幼民, 朱继业 . ( 2011).

中国器官捐献与分配相关问题初步探讨(2): 弹性假定同意器官捐献登记系统

中华移植杂志(电子版),5( 1),1‒4.]

URL     [本文引用: 1]

中国人均国民生产总值和人均医疗卫生投资较低,预示了在中国建立器官捐献系统较发达国家将会更加困难." 弹性假定同意"是经过多年多国实践检验的、能快速增加器官捐献率的知情同意法则,它既符合WHO器官捐献原则,在尊重供体捐献意愿的前提下,充分尊重家属 的知情同意权,同时也尊重不愿或不能捐献器官人群的人权,其经济易行的优点更加符合中国作为发展中国家的现实.心死亡器官捐献、高效率的器官捐献登记系 统、帮扶政策三者的有机结合,似乎更加符合中国现阶段国情,是中国器官捐献可持续发展需要深入研究和探讨的问题.

Xie W., Z. ( 2013).

Current situation and countermeasures study on organ donation after cardiac death in Hunan province (Unpublished doctoral dissertation). Central South University, Changsha

[本文引用: 1]

[ 谢文照 . ( 2013).

湖南省心脏死亡器官捐献现状与对策研究(博士学位论文)

中南大学,长沙.]

[本文引用: 1]

Zhao C.-X., Shen S.-C., Rao L.-L., Zheng R., Liu H., & Li S . ( 2017).

Suffering a loss is good fortune: Myth or reality?

Journal of Behavioral Decision Making, doi: 10.1002/bdm.2056

URL     [本文引用: 1]

We sometimes decide to take an offered option that results in apparent loss (e.g., unpaid overtime). Mainstream decision theory does not predict or explain this as a choice we want to make, whereas such a choice has long been described and highly regarded by the traditional Chinese dogma “吃亏是福” (suffering a loss is good fortune). To explore what makes the dogma work, we developed a celebrity anecdote‐based scale to measure “Chikui” (suffering a loss) likelihood and found that:(i) people with higher scores on the Chikui Likelihood Scale (CLS) were more likely to report higher scores on subjective well‐being and the Socioeconomic Index for the present and (ii) the current Socioeconomic Index could be positively predicted not only by current CLS scores but also by retrospective CLS scores recalled for the past, and the predictive effect was enhanced with increasing time intervals. Our findings suggest that “suffering a loss is good fortune” is not a myth but a certain reality. 08 2017 The Authors Journal of Behavioral Decision Making Published by John Wiley & Sons Ltd.

Zúñiga-Fajuri A.., (2015).

Increasing organ donation by presumed consent and allocation priority: Chile

Bulletin of the World Health Organization, 93(3), 199-202.

URL     PMID:4339830      [本文引用: 2]

Chile, a middle-income country, recently joined Israel and Singapore as the world鈥檚 only countries to require reciprocity as a precondition for organ transplantation. The Chilean reform includes opt-out provisions designed to foster donation and priority for organ transplantation for registered people. Although the reform has had serious difficulties in achieving its mission, it can be reviewed by other countries that seek to address the serious shortage of organs. As increased organ donation can substantially enhance or save more lives, the effect on organ availability due to incentives arising from rules of preference should not be underestimated.

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