Getting consent on organ donation

In a perfectly rational world, everyone must voluntarily donate their organs after death. 

This is because, a) we lose nothing in our life time, and b) the probability that we could be the beneficiaries of someone else’s organ donation increases by such action.  So in theory, nobody should have any objection to donating their organs posthumously. And yet, in reality, this is not always so.

As we live in a less than rational world, some of us are innately squeamish at the very thought of any bodily mutilation, even if it is after our death. Some of us may have religious reservations. Others may be too modest to allow a stranger take a look at their body! Ergo, not all of us like to donate our organs.

In fact, in many countries, citizens are required to decide whether or not to give away their organs after death for the benefit of other people.

Often, many hospitals ask their terminal patients to make a similar call. Research shows that the percentage of organ donations in such instances typically tend to cluster around either 20% or 80% and little in-between!

Now this is an intriguing conundrum, till we realise that this is on account of the ‘presumed consent’ clause which is practiced in many countries. Presumed consent means one is assumed to have given one’s consent (to donate one’s organs), unless one explicitly states otherwise. On the other hand, in countries where consent is not presumed, one has to explicitly sign one’s consent to donate one’s organs; otherwise consent is assumed denied.

In these columns earlier, we have spoken of behavioural inertia or status quo bias. Status quo bias is so innate to human nature that when consent is presumed given unless explicitly denied, few of us tend to change the status quo (which presumes consent), so that 80% of subjects end up donating their organs, with merely one-fifth of them disturbing the status quo to deny consent.  However, when consent is not presumed, the status quo bias favours our not giving consent (by doing nothing) and we have to change the status quo — which only about 20% of subjects do — to explicitly provide our consent. Clearly, how options are framed matters!

Presumed consent phenomenon can be seen in action almost everywhere today, especially among slick marketers. For example, we get all these routine and unsolicited invitations for sharing books, or pictures, or friends and anything else for that matter, from the mailboxes of people known to us.  Had we been unfortunate enough to have clicked on one of these emails and accepted the invite, our computer would have — to our utter embarrassment — generated identical invitations to all the contacts on our address book, and what is more, would have kept sending reminders to join in!

If we had been careful while accepting the invitations, we would have noticed the ‘presumed consent’ clause, wherein by accepting the invite we had unwittingly
consented to similar invites being sent from our mailbox to all our contacts!

Some marketers use the status quo bias and presumed consent even more imaginatively. We are offered a free subscription of a certain magazine for six months on trial basis and an option on whether to subscribe or not to subscribe to the magazine at the end of that trial period. Everyone finds this an acceptable offer.

Our acceptance involves our providing our mailing address, phone number and credit card number, which we are told would be used only in case we choose to subscribe at the end of the free trial period.

What we miss out on is the ‘presumed consent’ clause in fine print, according to which unless we explicitly write not to subscribe, subscription and even subsequent renewals will be presumed consented and our credit card accordingly charged and renewed, unless we write explicitly to stop the subscription and/or renewal.

Now, for a mere six month of free trial, the marketer ensures a long term subscription of nearly 80% of the population targeted!