Testing the Organ Donor Registration System in the Lab Danyang Li Department of Economics Introduction
Objectives
Experimental Design (cont.)
The current U.S. organ supply system fails to produce an adequate supply to satisfy the demand for transplantable organs. • 113,000 people in the U.S. are waiting for an organ transplant (UNOS). • Every year about 12,000 deceased individuals qualify to be donors; yet, only half actually donate (National Kidney Foundation). • Only 37% of U.S. residents are registered organ donors (Donate Life America). • Over past 15 years, 103,000 individual have died waiting for an organ (UNOS).
This project utilizes a laboratory experiment to evaluate the relative effectiveness of alternative policies for human organ donation registration. • We test the effect of changing the default choice of donation decision (opt-in versus opt-out). • We examine the interaction between different default choices and allocation rules (without versus with priority rule). • We measure the effect of neutral framing versus descriptive framing in policy evaluation experiments.
In the experiment, each subject lives a virtual life in each round. • In each round, each subject is assigned with one A organ and two B organs. • In each period of any round, each subject has a 10% probability of A organ failure and a 20% probability of B organ failure. • Whenever a subject has A organ failure, he will cease to participate in that round. • Whenever a subject has B organ failure, he will be placed on a waiting list to receive one B organ donated by others. • Each subject may remain on the waiting list for 5 periods. If subjects do not receive one B organ within this 5 periods, he will cease to participate in that round.
Experimental Design
Research Question The organ shortage in the U.S. has generated a lively political debate: what potential policy change might increase the organ supply in the U.S.?
We adopt a 2x2 design in this experiment, so that subjects make donation decision under 4 different conditions.
Without Priority
U.S. System and Proposed Policy Change U.S. Organ Supply System The current U.S. organ supply system mainly relies on altruistic donors. It is an opt-in registration system. The organ supply allocation is ranked according to patients’ medical condition and length of time on the waiting list. Organ Market The organ market concept corresponds with the classical economic view, however, it is considered unrealistic due to ethical concerns. Opt-out Registration System Under an opt-out system, anyone who has not
refused is presumed to be a donor. Countries with an opt-out system are Spain, Singapore, etc. Donors’ Priority Allocation Rule This system gives transplant priority to patient who have agreed to donate their organs. Countries with priority rule are Israel and Singapore.
RESEARCH POSTER PRESENTATION DESIGN © 2012
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With Priority
Opt-in Control Treatment Priority Treatment
Opt-out Opt-out Treatment Opt-out/priority Treatment
Control Treatment • In each round, subjects are not an organ donor by default. Subjects need to make an active decision to register themselves as a donor. • Ranks on the waiting list are determined by the length of time that one has been on the list.
Opt-out/priority Treatment • In each round, subjects are an organ donor by default. • After withdraw the donor registry, subjects also lose the donors’ priority.
Information Feedback
Results
Donation Decision At the beginning of each round, subjects are asked whether they want to register themselves as an organ donor (opt-in system) or whether they want to withdraw their donor registry (opt-out system).
Conclusion
Opt-out Treatment • In each round, subjects are an organ donor by default. Subjects need to make an active decision to withdraw their donor registry.
Priority Treatment • Registered organ donors receive priority in ranking on the waiting list.
Experimental Design (cont.)
Earnings and Costs • Subjects earn $3 in each period they have one active A organ and at least one active B organ. • An active donation decision costs $0.75. • The donation cost is $2.25.
• Both opt-out system and donors’ priority rule have a significant positive impact on donation registration. • Priority rule has a stronger impact than opt-out system. • More subjects choose to donate when the instruction is framed in terms of organ than when it is framed in neutral terms.
Contacts Danyang Li, danyang.li@hofstra.edu Zack Hawley, zhawley1@gsu.edu Kurt Schnier, kschnier@gsu.edu