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Medicine. Do defaults save lives?



The article discusses how should policy-makers choose defaults regarding organ donors. First, consider that every policy must have a no-action default, and defaults impose physical, cognitive, and, in the case of donation, emotional costs on those who must change their status. Second, note that defaults can lead to two kinds of misclassification, willing donors who are not identified or people who become donors against their wishes. Changes in defaults could increase donations in the United States of additional thousands of donors a year. Because each donor can be used for about three transplants, the consequences are substantial in lives saved.
ince 1995, more than 45,000 people in
the United States have died waiting
for a suitable donor organ. Although
an oft-cited poll (1) showed that 85% of
Americans approve of organ donation, less
than half had made a decision about donat-
ing, and fewer still (28%) had granted per-
mission by signing a donor card, a pattern
also observed in Germany, Spain, and
Sweden (24). Given the shortage of
donors, the gap between approval and ac-
tion is a matter of life and death.
What drives the decision to become a
potential donor? Within the European
Union, donation rates vary by nearly an or-
der of magnitude across countries and these
differences are stable from year to year.
Even when controlling for variables such as
transplant infrastructure, economic and ed-
ucational status, and religion (5), large dif-
ferences in donation rates persist. Why?
Most public policy choices have a no-
action default, that is, a condition is im-
posed when an individual fails to make a
decision (6, 7). In the case of organ dona-
tion, European countries have one of two
default policies. In presumed-consent
states, people are organ donors unless they
register not to be, and in explicit-consent
countries, nobody is an organ donor with-
out registering to be one.
According to a classical economics view,
preferences exist and are available to the de-
cision-maker—people simply find too little
value in organ donation. This view has led
to calls for the establishment of a regulated
market for the organs of the deceased (8, 9),
for the payment of donors or donors’ fami-
lies (10, 11), and even for suggestions that
organs should become public property upon
death (12). Calls for campaigns to change
public attitudes (13) are widespread. In clas-
sical economics, defaults should have a lim-
ited effect: when defaults are not consistent
with preferences, people would choose an
appropriate alternative.
A different hypothesis arises from re-
search depicting preferences as constructed,
that is, not yet articulated in the minds of
those who have not been asked (14–16). If
preferences for being an organ donor are
constructed, defaults can influence choices
in three ways: First, decision-makers might
believe that defaults are suggestions by the
policy-maker, which imply a recommended
action. Second, making a decision often in-
volves effort, whereas accepting the default
is effortless. Many people would rather
avoid making an active decision about dona-
tion, because it can be unpleasant and stress-
ful (17). Physical effort such as filling out a
form may also increase acceptance of the de-
fault (18). Finally, defaults often represent
the existing state or status quo, and change
usually involves a trade-off. Psychologists
have shown that losses loom larger than the
equivalent gains, a phenomenon known as
loss aversion (19). Thus, changes in the de-
fault may result in a change of choice.
Governments, companies, and public
agencies inadvertently run “natural experi-
ments” testing the power of defaults.
Studies of insurance choice (20), selection
of Internet privacy policies (21, 22), and
the level of pension savings (23) all show
large effects, often with substantial finan-
cial consequences.
Defaults and Organ Donations
We investigated the effect of defaults on
donation agreement rates in three studies.
The first used an online experiment (24):
161 respondents were asked whether they
would be donors on the basis of one of
three questions with varying defaults. In
the opt-in condition, participants were told
to assume that they had just moved to a
new state where the default was not to be
an organ donor, and they were given a
choice to confirm or change that status.
The opt-out condition was identical, except
the default was to be a donor. The third,
neutral condition simply required them to
choose with no prior default. Respondents
could at a mouse click change their choice,
largely eliminating effort explanations.
The form of the question had a dramat-
ic impact (see figure, left): Revealed dona-
tion rates were about twice as high when
opting-out as when opting-in. The opt-out
condition did not differ significantly from
the neutral condition (without a default op-
tion). Only the opt-in condition, the current
practice in the United States, was signifi-
cantly lower.
In the last two decades, a number of
European countries have had opt-in or opt-
out default options for individuals’ deci-
sions to become organ donors. Actual deci-
sions about organ donation may be affected
by governmental educational programs, the
Do Defaults Save Lives?
Eric J. Johnson* and Daniel Goldstein
The authors are at the Center for Decision Sciences,
Columbia University, New York, NY 10027, USA.
*To whom all correspondence should be addressed:
Opt-In Opt-Out Neutral
Percent consenting
to being donors
Effective consent rates, online experiment,
as a function of default.
99.91 99.97
99.5 99.64
Effective consent percentage
United Kingdom
Effective consent rates, by country. Explicit consent (opt-in, gold) and presumed consent (opt-
out, blue).
efforts of public health organizations, and
cultural and infrastructural factors. We ex-
amined the rate of agreement to become a
donor across European countries with ex-
plicit and presumed consent laws. We sup-
plemented the data reported in Gäbel (25)
by contacting the central registries for sever-
al countries, which allowed us to estimate
the effective consent rate, that is, the number
of people who had opted in (in explicit-con-
sent countries) or the number who had not
opted out (in presumed-consent countries).
If preferences concerning organ donation
are strong, we would expect defaults to have
little or no effect. However, as can be seen in
the figure (page 1338, bottom), defaults ap-
pear to make a large difference: the four opt-
in countries (gold) had lower rates than the
six opt-out countries (blue). The two distri-
butions have no overlap, and nearly 60 per-
centage points separate the two groups. One
reason these results appear to be greater than
those in our laboratory study is that the cost
of changing from the default is higher; it in-
volves filling out forms, making phone
calls, and sending mail. These low rates of
agreement to become a donor come, in
some cases, despite
marked efforts to in-
crease donation rates. In
the Netherlands, for ex-
ample, the 1998 cre-
ation of a national donor
registry was accompa-
nied by an extensive ed-
ucational campaign and
a mass mailing (of more
than 12 million letters in
a country of 15.8 mil-
lion) asking citizens to
register, which failed to
change the effective
consent rate (26).
Do increases in
agreement rates result
in increased rates of do-
nation? There are many reasons preventing
registered potential donors from actually
donating. These include: families’ objec-
tions to a loved one’s consent, doctors’ hes-
itancy to use a default option, and a mis-
match with potential recipients, as well as
differences in religion, culture, and infra-
To examine this, we analyzed the actual
number of cadaveric donations made per
million on a slightly larger list of countries,
with data from 1991 to 2001 (27). We ana-
lyzed these data using a multiple regression
analysis with the actual donation rates as de-
pendent measures and the default as a pre-
dictor variable. To control for other differ-
ences in countries’ propensity to donate,
transplant infrastructure, educational level,
and religion, we included variables known to
serve as proxies for these constructs (5) and
an indicator variable representing each year.
This analysis presents a strong conclu-
sion. Although there are no differences
across years, there is a strong effect of the de-
fault: When donation is the default, there is a
16.3% (P < 0.02) increase in donation, in-
creasing the donor rate from 14.1 to 16.4
million (see figure, this page, blue line).
Using similar techniques, but looking only at
1999 for a broader set of European countries,
including many more from Eastern Europe,
Gimbel et al. (5) report an increase in the
rate from 10.8 to 16.9, a 56.5% increase (see
figure, this page, red line). Differences in the
estimates of size may be due to differences in
the countries included in the analysis: Many
of the countries examined by Gimbel et al.
had much lower rates of donation.
How should policy-makers choose defaults?
First, consider that every policy must have a
no-action default, and defaults impose physi-
cal, cognitive, and, in the case of donation,
emotional costs on those who must change
their status. As noted earlier, both national
surveys and the no-de-
fault condition in our ex-
periment suggest that
most Americans favor
organ donation. This im-
plies that explicit con-
sent policies impose the
costs of switching on the
apparent majority (28).
Second, note that de-
faults can lead to two
kinds of misclassifica-
tion: willing donors
who are not identified
or people who become
donors against their
wishes. Balancing these
errors with the good
done by the lives saved
through organ transplantation leads to deli-
cate ethical and psychological questions.
These decisions should be informed by fur-
ther research examining the role of the three
causes of default effects. For example, one
might draw different conclusions if the ef-
fect of defaults on donation rates is due pri-
marily to the physical costs of responding,
than if they were due to loss aversion.
The tradeoff between errors of classifi-
cation and physical, cognitive, and emo-
tional costs must be made with the knowl-
edge that defaults make a large difference
in lives saved through transplantation.
Our data and those of Gimbel et al. sug-
gest changes in defaults could increase do-
nations in the United States of additional
thousands of donors a year. Because each
donor can be used for about three trans-
plants, the consequences are substantial in
lives saved. Our results stand in contrast
with the suggestion that defaults do not
matter (29). Policy-makers performing
analysis in this and other domains should
consider that defaults make a difference.
References and Notes
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plantation” (Gallup Organization, Princeton, NJ,1993).
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16. D. Kahneman, A. Tversky, Eds.,
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17. J. Baron, I. Ritov,
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19. A. Tversky, D. Kahneman,
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106(4), 1039
20. E. J. Johnson, J. Hershey, J. Meszaros, H. Kunreuther,
Risk Uncertainty
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21. S. Bellman, E. J. Johnson, G. L. Lohse,
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24. Methods and details of analysis are available as sup-
porting material on
25. H. Gäbel,“Donor and Non-Donor Registries in Europe”
(on behalf of the committee of experts on the
Organizational Aspects of Co-operation in Organ
Transplantation of the Council of Europe, Brussels,
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et al.
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27. We used a times series analysis to account for possi-
ble changes in transplant technology and infrastruc-
ture, as well as the effects of continuing public edu-
cation campaigns.
28. An alternative advocated by the American Medical
Association (
) is mandated choice, which imposes
the cost of making an active decision on all.This prac-
tice is currently employed in the state of Virginia, but,
consistent with the constructive preferences perspec-
tive, about 24% of the first million Virginians asked
said they were undecided (
29. A. L. Caplan,
272, 1708 (1994).
30. American Medical Association, “Strategies for cadav-
eric organ procurement: Mandated choice and pre-
sumed consent” (American Medical Association,
Chicago, 1993).
31. A. C. Klassen, D. K. Klassen,
Ann. Intern. Med.
32. This research has been supported by the Columbia
University Center for Decision Science and the
Columbia Business School Center for Excellence in E-
Business. We thank L. Roels for providing the data on
actual donation rates.
Supporting Online Material
Opt-in Opt-out
Donation rate per million
Estimated donation rate, opt-in versus
opt-out, as a function of default,
1991–2001. Means ± SEM; this paper,
blue; Gimbel
et al
), red.
... His suggestion was to move from an opt-in modelpeople actively must become organ donorsto an opt-out model, in which people are automatically listed as donors unless they, as the name suggests, opt-out. Spahn's plan to alter the default settings of organ donorship comes from a family of interventions known as Nudges; regarding organ donorship, the efficiency of such a change of defaults has already been researched by Johnson and Goldstein (2003). Nudges are currently employed by governments all around the world (cf. ...
... Kahneman 1992), the change of default decisions (cf. Johnson/Goldstein 2003;Dobelli 2012, 130), or branding something as a loss or gain 2 (cf. Tversky /Kahneman 1991;1992). ...
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Nudging can be considered the application-based offspring of psychological research, which has been focusing on the mismatch of decision-making modes, i.e., fast and slow thinking. Through conscious modification of decision architectures-all contextual, social, and cognitive aspects which potentially influence a decision-, Nudging promises to improve individual decisions and, through accumulation of these individual decisions, solve bigger problems. Currently, Nudging is considered a global trend in the field of politics as it promises to solve diverse sets of problems (health, tax compliance, traffic, retirement savings etc.) at almost zero costs. Further, Nudging claims to be in accordance with core democratic principles, such as free choice, liberty, and individualism etc. This article puts the claims of Nudge advocates to test by critically interrogating Nudging, its associated philosophy of liberal paternalism, its implicit assumptions, as well as its methodology. In order to present a holistic criticism of Nudging, this article draws from interdisciplinary sources - primarily psychology, philosophy, and political science - and identifies, and contextualizes the weaknesses and blind spots of Nudging. This article hopes to re-establish a more balanced view regarding the primarily positively discussed megatrend of Nudging.
... Many changes to decision architectures are motivated on the basis of 'paternalistic' reasoning, meaning that they intend to improve the welfare of the decision-maker, for example decreasing old-age poverty 5 or increasing health outcomes 6 . Other changes attempt to address externalities, promoting the creation of public goods (for example, deceased organ availability 7 and charitable giving 8 ). In the domain of climate change mitigation, such interventions can strongly increase the number of consumers who sign up for a green energy contract 9,10 , reduce their residential energy use 11,12 , switch to a more cost-effective energy contract 13 or increase their willingness-to-buy environmentally friendly consumer goods 14 . ...
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Behavioural public policy has received broad research attention, particularly in the domain of motivating pro-environmental behaviours. We investigate how far the efficacy of arguably one the most popular behavioural policy tools (green ‘default change’ nudges) depends on the associated cost. On the basis of a field study involving carbon offsets for over 30,000 flights booked by more than 11,000 airline customers, we show that green defaults have a large effect on voluntary climate action, even when several hundreds of Euros are at stake. The effect fully vanishes only as costs approach approximately €800. Berger et al. investigate green defaults under varying prices. Using field data from a flight compensation platform, they show that green defaults are effective. Their effectiveness, however, vanishes when costs become too high.
... As such, the default is the option in a choice set that individuals will automatically receive unless they actively opt-out and choose another option. They are found to be impactful in various decision-making contexts (Hummel and Maedche, 2019;Jachimowicz et al., 2019), for instance, in increasing the signup for organ donation (Johnson and Goldstein, 2003), and participation in retirement savings programs (Madrian and Shea, 2001). Several individual studies show that defaults also have the potential to reduce meat consumption. ...
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Meat consumption and production cause a significant share of greenhouse gas (GHG) emissions in the food sector. Behavioural food policy suggests using defaults-i.e., pre-setting a specific choice option-as an effective demand-side instrument to reduce meat consumption. This systematic review compiles, critically appraises, and synthesises existing empirical evidence on defaults that aim to reduce meat consumption. Beyond that, the underlying mechanisms and potential effect moderators in this context are explored. Our synthesis includes twelve individual studies comprising sixteen different default interventions. Although the extent of evidence is limited, we assess the quality to be relatively good. We find that defaults are effective in nudging consumers to eat less meat; despite heterogeneity in the design and implementation of interventions, virtually all studies find the default to reduce meat consumption. Moreover, our explorative analysis provides insights into how the default works in this context. First, we suppose the default primarily operates through the underlying mechanisms of endorsement and effort. Second, we identify four contextual moderators-namely the default's inva-siveness, the recognisability and presentation of the alternative, and the objective of the study setting-that appear to influence the impact. We conclude that defaults are a promising tool for climate-sensitive food policy. Future research could verify and quantify the causal impact of mechanisms and moderators, and assess defaults' long-term and large-scale effectiveness.
... For purposes of this paper, we are particularly interested in the price stabilizing effect of recommended prices. Default, or recommended, options, as a popular behavioral economics tool, has been empirically tested in many policies, such as organ donation (Johnson and Goldstein, 2003), pension saving (Madrian and Shea, 2001), and product choices (Park, Jun and MacInnis, 2000). Metcalfe and Dolan (2012) discussed the potential of using behavioral economic principles in transport. ...
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The increased usage of alternative transportation modes during public transportation disruptions has been well documented in the literature. While many papers discuss the resilience of the disrupted mode or measure changes in the usage of various alternative modes, little research has addressed the capacity flexibility and the price fluctuations of the alternative modes—two important components of the quality of a transport mode. This paper documents the capacity and price resilience of BlaBlaCar during the nationwide French railway strike in 2018. We collected more than 1 million trip offers from the BlaBlaCar’s API from April to July 2018, covering 82 representative intercity routes in France. Our empirical analysis shows that, on an average strike day, the number of offered seats increased significantly by approximately 6%, while the number of booked seats rose by 31%. Despite the spikes in demand, prices remained stable during the strike. We argue that the price recommendation mechanism helped maintain the price stability on the platform during the strike. The mechanism is in fact an effective enforcement of the policy laid down by the French government to uphold the cost-sharing principle on ridesharing platforms. This paper documents a voluntary compliance by a private company to put in place a price recommendation mechanism that in effect stabilizes prices and contributes to the resilience of the whole transportation system against abnormal market conditions.
... Defaults are a type of nudge that involves setting a course of action that will unfold unless the person actively chooses otherwise. One classic default study concerned opting in vs. opting out of registering as an organ donor [49]. When registration was the default and people had to opt out of becoming a donor, registration rates were dramatically higher compared to a condition wherein participants had to opt-in to become a donor. ...
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Importance: In prior studies, decreasing the default number of doses in opioid prescriptions written in electronic health record systems reduced opioid prescribing. However, these studies did not rigorously assess patient-reported outcomes, and few included pediatric patients. Objective: To evaluate the association between decreasing the default number of doses in opioid prescriptions written in electronic health record systems and opioid prescribing and patient-reported outcomes among adolescents and young adults undergoing tonsillectomy. Design, setting, and participants: This nonrandomized clinical trial included adolescents and young adults aged 12 to 50 years undergoing tonsillectomy from October 1, 2019, through July 31, 2021, at a tertiary medical center. The treatment group comprised patients from a pediatric otolaryngology service (mostly aged 12-21 years) and the control group comprised patients from a general otolaryngology service (mostly aged 18-25 years). Interventions: Data on patient-reported opioid consumption and outcomes were collected via a survey on postoperative day 14. Based on opioid consumption among pediatric otolaryngology patients before the intervention, the default number of opioid doses was decreased from 30 to 12 in a tonsillectomy order set. This change occurred only for pediatric otolaryngology patients. Main outcomes and measures: Proportion of patients with 12 doses in the discharge opioid prescription, number of doses in this prescription, and refills and pain-related visits within 2 weeks of surgery. In a secondary analysis of patients completing the postoperative survey, patient-reported opioid consumption, pain control, sleep disturbance, anxiety, and depression were assessed. Linear or log-linear difference-in-differences models were fitted, adjusting for patients' demographic characteristics and presence of a mental health or substance use disorder. Results: The study included 237 patients (147 female patients [62.0%]; mean [SD] age, 17.3 [3.6] years). Among 131 pediatric otolaryngology patients, 1 of 70 (1.4%) in the preintervention period and 27 of 61 (44.3%) in the postintervention period had 12 doses in the discharge opioid prescription (differential change, 45.5 percentage points; 95% CI, 32.2-58.8 percentage points). Among pediatric otolaryngology patients, the mean (SD) number of doses prescribed in the preintervention period was 22.3 (7.4) and in the postintervention period was 16.1 (6.5) (differential percentage change, -29.2%; 95% CI, -43.2% to -11.7%). The intervention was not associated with changes in refills or pain-related visits. The secondary analysis included 150 patients. The intervention was not associated with changes in patient-reported outcomes except for a 3.5-point (95% CI, 1.5-5.5 points) differential increase in a sleep disturbance score that ranged from 4 to 20, with higher scores indicating poorer sleep quality. Conclusions and relevance: This nonrandomized clinical trial suggests that evidence-based default dosing settings may decrease perioperative opioid prescribing among adolescents and young adults undergoing tonsillectomy, without compromising analgesia. Trial registration: Identifier: NCT04066829.
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Many households include children who use voice personal assistants (VPA) such as Amazon Alexa. Children benefit from the rich functionalities of VPAs and third-party apps but are also exposed to new risks in the VPA ecosystem. In this paper, we first investigate “risky” child-directed voice apps that contain inappropriate content or ask for personal information through voice interactions. We build SkillBot — a natural language processing (NLP)-based system to automatically interact with VPA apps and analyze the resulting conversations. We find 28 risky child-directed apps and maintain a growing dataset of 31,966 non-overlapping app behaviors collected from 3,434 Alexa apps. Our findings suggest that although child-directed VPA apps are subject to stricter policy requirements and more intensive vetting, children remain vulnerable to inappropriate content and privacy violations. We then conduct a user study showing that parents are concerned about the identified risky apps. Many parents do not believe that these apps are available and designed for families/kids, although these apps are actually published in Amazon’s “Kids” product category. We also find that parents often neglect basic precautions such as enabling parental controls on Alexa devices. Finally, we identify a novel risk in the VPA ecosystem: confounding utterances, or voice commands shared by multiple apps that may cause a user to interact with a different app than intended. We identify 4,487 confounding utterances, including 581 shared by child-directed and non-child-directed apps. We find that 27% of these confounding utterances prioritize invoking a non-child-directed app over a child-directed app. This indicates that children are at real risk of accidentally invoking non-child-directed apps due to confounding utterances.
Behavioral policies Nudge and Boost are often advocated as good candidates for evidence-based policy. Nudges present or “frame” options in a way that trigger people’s decision-making flaws and steer into the direction of better choices. Nudge aims to do this without changing the options themselves. Boosts also present choices in alternative ways without changing options. However, rather than steering, Boosts are aimed to increase people’s competences. Nudge and Boost originated in extensive research programs: the “heuristics-and-biases program” and the “fast-and-frugal heuristics program,” respectively. How exactly do Nudge and Boost policies relate to the theories they originated from in the first place? Grüne-Yanoff and Hertwig labeled this a question of “theory-policy coherence” and propose to use it for determining the evidence-base of Nudge and Boost. I explore the question: “In how far is theory-policy coherence in Nudge and Boost relevant for evidence-based policymaking?.” I argue that the implications of (weaker or stronger) theory-policy coherence are relevant in two ways. First, Grüne-Yanoff and Hertwig show that theory-policy coherence between Nudge and Boost and the research programs is not as strong as often assumed. It is crucial for the evidence-based policymaker to realize this. Assuming theory-policy coherence while it does not exist or is weaker than assumed can lead to an incorrect assessment of evidence. Ultimately it can even lead to adoption of policies on false grounds. Second, the concept of theory-policy coherence may assist the policymaker in the search and evaluation of (mechanistic) evidence. However, in order to do so, it is important to consider the limitations of theory-policy coherence. It can neither be employed as the (sole) criterion with which to determine how well-grounded a policy is in theory, nor be the (sole) basis for making comparative evaluations between policies.
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Differences in opt-in and opt-out responses are an important element of the current public debate concerning on-line privacy and more generally for permission marketing. We explored the issue empirically. Using two on-line experiments we show that the default has a major role in determining revealed preferences for further contact with a Web site. We then explore the origins of these differences showing that both framing and defaults have separate and additive effects in affecting the construction of preferences.
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Permission marketing requires consumers' consent before a Web site can track them with cookies, or send them marketing email, or sell their data to another company. Yet a study conducted by Cyber Dialogue Inc. found that 69% of U.S. Internet users did not know they had given their consent to be included on email distribution lists. Using the right combination of question framing and default answer, an online organization can almost guarantee it will get the consent of nearly every visitor to its site. Although lists of people who have supposedly opted-in for permission marketing schemes are valuable sources of revenue for Web sites, high response rates alone do not mean these lists contain valuable customers. They systematically explored the influence of question framing and response defaults on consumers' apparent privacy preferences in two online experiments detailed. Participants in these experiments were members of the Wharton Virtual Test Market, an online panel of over 30,000 Internet users representative of the U.S. Internet population. Results of experiments highlight the need for all online consumers to pay close attention to what they agree to when they send responses to a Web site. If consumers had fixed policies about the privacy of their data, then asking them to opt-out or opt-in to a Web site's privacy policy would make no difference to their answer.
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Regulation by the state can take a variety of forms. Some regulations are aimed entirely at redistribution, such as when we tax the rich and give to the poor. Other regulations seek to counteract externalities by restricting behavior in a way that imposes harm on an individual basis but yields net societal benefits. A good example is taxation to fund public goods such as roads. In such situations, an individual would be better off if she alone were exempt from the tax; she benefits when everyone (including herself) must pay the tax.
Context Few studies on presumed consent and environmental predictors of cadaveric organ donation in Europe have been published. Objective To determine if a presumed consent policy and other variables can be used to predict the cadaveric organ donation rate per million population. Design Secondary analysis of published data. Setting Europe. Participants The unit of analysis for this study is the individual country. Main Outcome Measure Cadaveric organ donation rate per million population. Results Original and transformed data were subjected to ordinary least-squares regression. All 4 independent variables were significant predictors of cadaveric donation rate, including (1) having a presumed consent (opting-out) policy in practice, (2) number of transplant centers per million population, (3) percentage of the population enrolled in third-tier education, and (4) percentage of population that is Roman Catholic. Conclusion Findings may be useful to academics and professionals responsible for organ procurement. Additional research is necessary for practical application of findings. Generalizing these findings beyond Europe may be problematic because of external validity constraints.
The American Medical Association has just voted to encourage studies that would determine whether financial incentives would increase the pool of donor organs from cadavers.1 The association is only eight years behind a proposal that we made, outlining probably the only circumstances in which a market in donor organs could be achieved ethically and in a way that minimised the dangers of such a scheme. This is how an ethical market in live organs would work. To meet legitimate ethical and regulatory concerns any such scheme must have built into it safeguards against wrongful exploitation and show concern for vulnerable people, as well as taking into account considerations of justice and equity. If all this can be done then a market in human body products will be shown to be, at the very least, not prima facie unethical.2 One way of attending to this need for prudent regulation would be to establish a monopsony, a situation where only one buyer exists for the products of several sellers.3 The one legitimate purchaser in the marketplace would be required to take on responsibility for ensuring equitable distribution of all organs and tissues purchased. This would prevent the rich using their purchasing power to exploit …
THE SCARCITY OF ORGANS FOR TRANSPLANTATION The shortage of organs for transplantation is becoming more critical every year. Because of improvements in transplantation procedures, beginning with the advent of immunosuppressive therapies in the early 1980s, more patients now benefit from organ transplantation. As a result of transplantation's success, waiting lists for donor organs are increasingly crowded. Between December 1987 and June 1991, for example, the total number of patients on organ transplant waiting lists increased 75.3%, from 13153 to 23 056 patients.1
Behavioral decision research: A constructive processing perspective
One of the main themes that has emerged from behavioral decision research during the past 2 decades is the view that people's preferences are often constructed in the process of elicitation. This concept is derived in part from studies demonstrating that normatively equivalent methods of elicitation often give rise to systematically different responses. These "preference reversals" violate the principle of procedure invariance that is fundamental to theories of rational choice and raise difficult questions about the nature of human values. If different elicitation procedures produce different orderings of options, how can preferences be defined and in what sense do they exist? Describing and explaining such failures of invariance will require choice models of far greater complexity than the traditional models. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Much experimental evidence indicates that choice depends on the status quo or reference level: changes of reference point often lead to reversals of preference. The authors present a reference-dependent theory of consumer choice, which explains such effects by a deformation of indifference curves about the reference point. The central assumption of the theory is that losses and disadvantages have greater impact on preferences than gains and advantages. Implications of loss aversion for economic behavior are considered. Copyright 1991, the President and Fellows of Harvard College and the Massachusetts Institute of Technology.