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 *

doi:10.3724/SP.J.1041.2018.00868

摘要/Abstract

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.

Key words: organ donation, nudging, default option effect, response mode, sequence effect

中图分类号:

B849:C91

黄元娜, 宋星云, 邵洋, 李纾, 梁竹苑. (2018). 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 ^*. 心理学报, 50(8), 868-879.

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.

图/表 4

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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%

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%

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	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)
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%

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	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)
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%

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	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)
拒绝	升序	53	26.42%	21.64 ± 2.40	13.20%	70.0% ± 10.1%
拒绝	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%
接受	降序	56	25.00%	21.48 ± 2.78	1.79%	71.7% ± 10.6%