Case Study 1: Opt-Out Organ Donation
Case Study 2: Save More Tomorrow
Case Study 3: Choice Architecture in the Cafeteria

Case Study 1: Opt Out Organ Donation

The substantial effect that the default position can have on people’s choices is a classic finding of behavioural economics. This finding has been famously applied to address the problem of the lack of organ donors in the UK. The UK has an ‘opt-in’ donor system – you have to register to be a donor – and like Denmark, Germany and the Netherlands, struggles to get a high percentage of the population registered. Other countries like Belgium, Austria and France, have an ‘opt-out’ system, that is, you have to register not to be a donor. In those countries, at least 90%, and even 100% of the adult population are registered as donors. A very simple difference in the default position appears to cause a dramatic difference in registered donors. Ireland is planning to move to the opt-out system. For the first time, it will be presumed that the deceased person had consented to donate major organs, including kidneys, heart, lungs and liver. Think about this policy in terms of the FORGOOD framework.

The below interpretations of the seven considerations are suggestions and different people will think of these differently.

Does the behavioural policy have undesired redistributive effects?

No. The behavioural policy does not focus nor neglect one group in favour of another. It does not lead to a subset of the population behaving against their best interests nor to a re-allocation of resources.

Is the behavioural policy open or hidden and manipulative? 

The policy is transparent because its goal, rationale and methodology was publicly announced and subject to scrutiny by the public. It is possible for people to identify the policy and its influence and impact.

Does the policy respect people’s autonomy, dignity, freedom of choice and privacy?

Under the opt-out system, it is presumed that a deceased person has consented to donate their vital organs. The opt-out policy is a potential violation of the donor’s autonomy and freedom to choose what they wish to do with their body after their death.

Does the behavioural policy serve good and legitimate goals? 

The behavioural intervention serves goals that are ethically acceptable and aims to improve people’s lives: increasing the number of donated organs available that can be used in medical procedures; this would lead to decreased waiting times and could save people’s lives.

Do people accept the means and the ends of the behavioural policy? 

Public opinion of opt-out organ donation is mixed, with some groups lobbying for the policy and others accusing it of being misleading. Policymakers need to consider how much disagreement is acceptable and measure the extent of it through surveys and opinion polls. A strong justification for the nudge is present when nudgers and a large majority of the nudgees agree about both the ends and the means of the policy.

Do better policies exist and are they warranted? 

There are other policy options available, hard interventions like bans, mandates or incentives, these too can be motivated by behavioural insights. Some researchers argue that nudges are very cost-effective but others warn that the effectiveness of behavioural policies might well be limited in comparison to harder policies. Policymakers need to run a cost-benefit analysis to compare different policies and must consider the possibility of unwanted side-effects of the nudge.

Do the policy-makers have the right and the ability to nudge using the power delegated to them? 

The policy-makers have no conflicts of interest in implementing this nudge. The opt-out behavioural intervention was designed using a strong scientific base and will be implemented by policy-makers who have the competency to administer and evaluate the behavioural policy properly.

Case Study 2