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

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

 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.

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

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

### 1.1 助推器官捐献的行为经济学手段

1.1.1 器官捐献制度设计：默认选项效应

1.1.2 器官捐献登记表设计：登记表的架构和呈现方式

2.2.1 被试

2.2.2 研究设计和流程

### 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。

### 3.2 研究方法

3.2.1 被试

3.2.2 研究设计和流程

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

□肾脏 □肝脏 □心脏 □肺脏 □胰腺 □小肠 □胰岛细胞 □眼角膜

(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?

a. 器官移植和科学研究 b. 仅供器官移植 c. 仅供科学研究

4.2.1 被试

4.2.2 研究设计与流程

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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.