DEFAULTS AND ORGAN DONATION IN ROMANIA

Andrei Vlăducu – ResearcherDan Dobre – Researcher

David Diaconu – ResearcherBogdan Deaconu – Researcher

Center for Behavioral Studies

I. ORGAN DONATION. A MATTER OF PUBLIC POLICY

Patients enrolled on the waiting list for a transplant in RO

(2012)

Nr. of transplants in RO (2012)

Percent of enrolled patients on waiting lists who benefited for a transplat in RO

(2012)

Kidney: 3,371 Kidney: 177 5.25%

Liver: 475 Liver: 75 15.78%

Heart: 123 Heart: 2 1.62%

Pancreas: 71 Pancreas: 0 0%

(Source: www.e-transplant.ro , consulted in November 2014)

(Source: www.e-transplant.ro , consulted in November 2014)

Mean: 5.6%

2013 2012 2011 2010 2009 2008 2007 2006 2005

132

6577

70

42

60

3622

116.6 3.42 3.67 3.3 2 2.9 1.71 1.04 0.52

212

154 159

117 112

70

44

14

46 45 4535

70

3422

3

nr. of donors pmp interw_don refusal

Evolution of: number of donors, pmp, interwies with potential donors, number of refusal after interview during 2005 – 2013 in Romania (source: www.transplant.ro , consulted in may 2015).

Nr. Counrty Number of deceased donors Donor rates to 1 million people (pmp)1 Spain 1667 35,32 Croatia 148 33,63 Belgium 331 30,14 Malta 12 305 Portugal 301 28,16 France 1630 257 Norwey 127 24,58 Austria 205 24,49 Italy 1325 21,8

10 Irland 93 20,711 Latvia 40 18,212 Luxemburg 9 1813 Czech 185 17,6

  EU (mean) 329 17,514 Finland 93 17,215 UK 1056 17

16 Estonia 22 16,917 Slovenia 31 15,518 Sweden 146 15,519 Germany 1200 14,720 Poland 553 14,421 Netherlands 227 13,622 Hungary 131 13,123 Denmark 73 1324 Slovakia 69 12,525 Lithuania 39 11,826 Greece 79 6,927 Island 2 6,728 Cyprus 6 5,529 Romania 77 3,630 Bulgaria 4 0,5

The number and rates of organ donors per 1 million people in 2010 (Source: Eurobarometer 333a, 2010)

The process of organ donation/transplantation involves several steps:

Existence of consent on willingness to be a donor. Death in certain conditions of the organ donor. Existence of the necessary infrastructure for the removal of organs and transplant. Compatibility between the patient and transplatend organ.

Solutions to increase the number of organ donors: a market reguling the organs of the deceased (Johson and Goldstein, 2003).

payng donors and their families (Johson and Goldstein, 2003).

issuing the idea that organs should become public property after death (Johson and Goldstein, 2003).

campaigns to change public attitudes on this issue (Johson and Goldstein, 2003).

taking the organs from criminals after their death to compensate their victims (Whitehead and Block, 2002).

increasing the number of living organ donors (Loop, 2013).

organ donors default change (Johson and Goldstein, 2003).

2. THE HEURISTICS AND BIASES APPROACH

in Romania, the status-qvo is represented by „being a donor by choice” witch means that if you want to become a donor it needs to express your consent by fulfilling certain bureaucratic procedures.

the two possible legislative approches in the field of organ donation are: 1. Being an implicit donor (named the opt-out system) and 2. Being a donor by consent (named the opt-in system) (Johnson and Goldstein, 2003).

The way we are defining the context can influence choices and individual preferences – framing effect (Lichtenstein and Slovic: 1971, Kahneman and Tversky: 1979, Slovic and Lichtenstein: 1983, Butler and Loomes: 2007, Tversky and Kahneman: 2000).

individuals tend to remain at the status-qvo and this is called the status-qvo bias.

Effective consent rates, by country. Explicit consent (opt-in, gold) and presumed consent (opt-out, blue) (Source: Johnson and Goldstein, 2008, 1338)

3. RESEARCH QUESTIONS AND HYPOTHESES

Research Question:RQ1: How students will behave according to the type of default (opt-in, opt-out) used in terms of organ donation consent rate?

Hypotheses:H1: Grade of organ donors consent will be higher for the the group who will have an opt-out default than for the groups who will have an opt-in or neutral default.

Definitions:Predictor (independent) variable DEFAULT = how you define the default on organ-consent: default donor (opt-out), donor by choice (opt-in), individuals faced with a choice between being organ donors or not in an neutral context (neutral).

Outcome (dependent) variable CONSENT = willingness of the participants to the experiment to become organ donors.

4. METHOD

Lab Experiment. Between-Subjects Design. Participants: 286 undergraduates (Faculty of Political Science, Faculty of Public Administration, Faculty of

Communication and Public Relations – NUPSPA, Faculty of Law – Titulescu University). Pre-testing experiment. Random distribution of the participants between the three conditions.

Socio-demographic caracteristics of the participants to the experiment: 70% female, 30% male Avarage age: 19.8 years old 81% urban, 19% rural The majority (67%) have an income between 500-2000 RON

EXPERIMENTAL CONDITIONS

C1 (Opt-out): Imagine that you moved in other country and became citizen of it. According to that country legislation, any citizen after her/his death is automatically an organ donor. Also, the same legislation permits to resign this status of being an organ donor. In this case, what will you choose:

A) Keep the organ donor status B) Resign the organ donor staturs

C2 (Opt-in): Imagine that you moved in other country and became citizen of it. According to that country legislation, any citizen after her/his death is not automatically an organ donor. Also, the same legislation permits to became an organ donor. In this case, what will you choose:

A) Keep the non-organ donor status B) Become an organ donor

C3 (Neutral): Imagine that you moved in other country and became citizen of it. According to that country legislations you must choose whether to become or not an organ donor. In this case, what will you choose:

A) I choose not to become an organ donor B) I choose to become an organ donor

5. RESULTS

Opt-out Opt-in Neutral0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

90%

75%72%

RQ1: How students will behave according to the type of default (opt-in, opt-out) used in terms of organ donation consent rate?

5. RESULTS

H1: Grade of organ donors consent will be higher for the the group who will have an opt-out default than for the groups who will have an opt-in or neutral default.

Pearson Chi-

Square

Value Df Asymp. Sig. (2-

sided)

Opt-Out –

Neutral

5,580a 1 .018

Opt-In –

Neutral

,122b 1 .727

a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 5,77.

b. a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 9,26.

based on the odds ratio, the odds of subject consent for donation were 3,46 times higher in the opt-out condition compared with the opt-in condition.

6. GENERAL DISCUSSIONS AND LIMITS

RQ1 show that opt-out condition provide the highest degree of organ consent (90%).

H1 is confirmed (organ donors consent is higher for the the group who will have an opt-out default than for the groups who will have an opt-in or neutral default)

Change of the default could be less expensive (in financially terms) than information and awareness campaigns.

Change of the defaltul appears to be an effective solution to increase the number of organ donors.

External validity of the experiment - incresing and diversifying the sample with non-students.

Donation and transplantation involve a systematic process in several stages, each of them must be discussed.

Bibliography:333a, Eurobarometru. 2010. Organ Donation and Transplantation. June. Accesat octombrie 2014. http://ec.europa.eu/public_opinion/index_en.htm.Butler, J., David and Loomes, C., Graham (2007), Imprecision as an Account of the Preference Reversal Phenomenon, The American Economic Review 97: 277-297.Commission, European. 2012. Journal Workshop. Organ Donation And Transplantation, Fact & Figures. European Commission.Johnson, Eric J., and Daniel Goldstein. 2003. "Do Defaults Save Lifes?" Science 1338-1339.Kahneman, Daniel, and Amos Tversky. 1979. "Prospect Theory: An analysis of Decision under Risk." Econometrica 47 (2): 263-292.Lichtenstein, Sarah and Slovic, Paul. 1971, Reversals of prefere between bids and choices in gambling decisions, Journal of Experimental Psychology 89: 46-65. Kahneman, Daniel and Tversky, Amos. 2000. Choices, Values, and Frames, Cambridge University Press.Lopp, Leonie. 2013. Regulations Regarding Living Organ Donations in Europe. Berlin: Springer.Morton, Rebeca, and Kenneth Williams. 2010. Experimental Political Science and the Study of Causality: From Nature to the Lab. New York: Cambridge University Press.Slovic, Paul and Lichtenstein, Sarah. 1983, Preference Reversals: A Broader Perspective, The American Economic Review 73: 596-605.Whitehead, Roy, and Walter Block. 2002. "Taking the assets of criminals to compensate victims of violence: a legal and philosophical approach." Journal of Law and Society 5: 229-253.

http://www.e-transplant.ro/www.transplant.ro

Ordin 1158/2012 Ordin privind înfiinţarea Registrului naţional al donatorilor de organe, ţesuturi şi cellule (http://lege5.ro/Gratuit/gmztmnbvgy/ordinul-nr-1158-2012-privind-infiintarea-registrului-national-al-donatorilor-de-organe-tesuturi-si-celule )

Thank YouAny suggestion, commentary, critics, etc. it is expected

at:

contact@comportamentale.ro

We can also provide the database on request.