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There are currently more than 100,000
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people on organ donor lists right now
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here in the United States and every 8
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minutes another person is added to one
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of those lists. Approximately 48,000
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transplants took place in 2024 but the
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numbers of people saying that they will
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donate organs continues to be a an
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important topic to look at. Data shows
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that about two in five people uh say
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that they are registered to donate
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organs. But how do you get that number
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higher so that we can potentially help
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those in need? Pleasure to be joined
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here in studio by Jud Kesler, professor
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in the business economics and public
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policy department here at the Wharton
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School. He has done some research deeper
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dive into this and he joins me here in
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the studio. Great to see you.
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>> Thanks for having me.
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>> The focus of this research was around
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how you can connect with those people,
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but in part the vehicle, pun intended,
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of doing this was through the DMV.
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>> Yeah. So, if you have gotten a driver's
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license in the United States, you almost
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certainly went to your state's
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Department of Motor Vehicles and filled
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out a form. And on that form, kind of by
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historical accident, we ask people uh if
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they want to register as an organ donor,
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right? Um and you know, as you said at
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the start, there's lots of people who
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are waiting for a life-saving organ
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transplant. A lot of people in
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particular are waiting for kidneys
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because you can live for a long time
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with kidney failure if you get on
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dialysis. Um, and so these people are
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waiting for somebody to die in a way
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that will allow their organs to be made
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available for transplant. But part of
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that is the person or their next of kin
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saying, "Yes, you can have my organs uh
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when I when I die." And historically,
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the request to get on this registry of
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basically saying in advance before
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death, I would like to be an organ donor
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was done at the DMV because the DMV
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gives you a piece of plastic that you
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put in your wallet and uh will probably
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be on you in the event of an untimely
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demise and and that can say, you know,
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that you're an organ donor on it. for a
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long time before there were databases
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that that stored this information that
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was going to be how people um were kind
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of identified as donors. Now we have
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other ways to check whether they're a
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donor or not but we still ask people do
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you want to register as an organ donor
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at the DMV,
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>> right? And so how is the best way then
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potentially to go about this because is
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the DMV the right spot? So this is uh a
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question that folks have been thinking
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about for a long time because this list
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of folks waiting for a life sa saving
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organ transplant is long and you know is
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not not getting shorter. Uh you know
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people are getting transplants but
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enough people are being added to the
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lists that uh they're not really
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shrinking. Um so uh how folks get asked
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at the DMV is something that we have
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thought about for a long time and one of
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the things that people thought was look
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only you know two you said two and five
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some some estimates put it closer to 50%
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of people are registered as donors have
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said yes at the DMV right
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>> um but if you ask people do you support
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organ donation the rates at which people
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say yes I support organ donation are
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north of 90%. Right? And so the thought
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was maybe people support organ donation
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but we're not asking them to become
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donors in the right way. And there was a
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thought for a long time that uh what we
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should do is change the way that we ask
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at the DMV. Now those who've heard about
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you know organ donation before might
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think oh we should do opt out like
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that's what a lot of countries do and
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and that is basically assuming
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everybody's an organ donor and then the
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question is do you want to remove
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yourself?
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>> Turns out that doesn't fly under uh US
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law. So, you know, US law organ donation
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is uh falls under the gift act and so
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you have to like make an affirmative
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statement that you want to be a donor,
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right?
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>> Um so, in that case, you basically have
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a more limited set of options of how to
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ask.
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>> One way is to do what's called an opt-in
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where you just, you know, give people
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the option to check a box or sign a form
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or sign, you know, sign on the form to
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say yes, I want to be a donor. Um, and
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if you leave that section blank, then
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you, you know, that's fine because
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that's just saying, you know, I'm not
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doing it today.
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>> Um, another way you could ask is with a
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yes no question where you say, do you
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want to be a donor? Yes or no? Or maybe
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no, not at this time. Um, but the idea
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behind that is in that case, you have to
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say something. You have to answer. And
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you know, theoretically, you know, if
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you if you fill out the form at the DMV
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and you hand it in and you haven't
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answered that question, the the uh DMV
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officer could say, "Actually, you
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haven't, you know, answer question
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seven. Could you could you do that?" And
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the thought was for for a while uh that
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if you asked as a yes no question, it
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would force all that 90% of people who
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say they support to kind of think about
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it, pay attention, um and and say yes.
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And and there was some hypothetical data
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that supported that. And we were curious
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if that was in fact true. What I find
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interesting is that and you mentioned
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about you know there's support for organ
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donation in general north of 90%.
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But are people recognizing the
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information as they're going through
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this process of either doing that yes no
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question or or opting in?
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>> Yeah. and and the possibility that the
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way you ask the question, you know,
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might affect how people decide to to say
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yes or no kind of relies on this idea
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that the way that we ask kind of conveys
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something or communicates something or
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gets people to think carefully about the
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decision in a way that they would not
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otherwise do it. And the the prior
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research that I mentioned had in fact
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found if you ask people in a
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hypothetical situation, you've moved to
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a new state, the default is, you know,
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there's no organ, you're not an organ
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donor unless you you opt in. Do you want
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to opt in?
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>> Um, you know, in that data, they found
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it was, you know, about 42%. Kind of
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close to the number that we we get now.
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Um, when when you ask people that way,
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but in their hypothetical study, if you
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asked, would you like to be a donor?
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Yes. No. you know, you're in a state
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that that doesn't have a a optin but has
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a yes no question. Um what what do you
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want to do now? They found that the rate
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skyrocketed. It was like in the high7s
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if you if you made them say, you know,
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yes or no, right?
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>> Um and so then that led us to think, oh
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wow, like that would be that would be
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great if it worked like that in practice
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when people's real organs were at stake.
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Um, and a lot of states based, I think,
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in part on that research had kind of
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done legislation to to change the way
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that the question was asked at the DMV.
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Um, and so then we decided, all right,
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we're going to test this out. We're
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going to look at the changes that have
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been made in practice, and we're going
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to do a a more controlled experiment to
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see if the question wording matters.
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>> And the results were
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>> uh not great uh for folks who thought
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that the question wording would would be
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important. So, it turns out that there's
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no effect. That's the topline result. we
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do not find any effect when it's real
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organ donor registration decisions,
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>> right?
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>> We don't find any effect of the question
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wording. Um, and we we did this in two
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different ways. Uh, the first way was
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designing a kind of uh front-end
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interface for the Massachusetts Registry
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of Motor Vehicles. Um, so subjects would
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come into the laboratory. This I did
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when I was I started this project long
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long time. Started when I was still a
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PhD student at Harvard. So, they'd come
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into the lab at Harvard and uh they knew
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that they needed the last four digits of
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their social. They knew they needed
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their Massachusetts ID number. Um but
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they didn't know that it was about organ
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donation. So, they show up and then we
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say, "Okay, you're going to log into the
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Massachusetts Registry of Motor
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Vehicles. You're going to see your organ
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and tissue donor status and then you're
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going to have the chance to change it if
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you want."
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>> Sure. Um, but we built a front end that
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let us change the specific way in which
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the question was asked. So, uh, you
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know, you got the same kind of
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information that was on the
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Massachusetts website. Um, but when you
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had a chance to decide if you wanted to
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register, we framed it either as a
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checkbox and opt in or as a yes no to
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see, you know, randomly assigned whether
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that would make a difference.
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>> What do you think then this tells us
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about what we need to do around organ
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donation? So the fact that our study
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revealed that it didn't matter how you
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asked uh was kind of disappointing to
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the you know h question framing
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mattering and I should say when we
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looked at the state data we found the
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same thing. So when California changed
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their wording on the form and when New
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York changed the wording on the form
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like it did not lead to an increase uh
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in donations when they went from opt-in
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to yes no. um and we compared them to
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other states to kind of do a kind of
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fair comparison over time and um you
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know the the did the best methods we
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could with that data and found no
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effect. But what was interesting and
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what was reassuring in our study um is
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that folks came in some of whom had
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already registered as donors, some of
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whom had had not registered. So, we got
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to see both groups and in our study, you
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know, you got asked, do you want to
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change your donor status? And so, you
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could change it in either direction. If
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you were already a donor, you could say,
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you know what, I thought more about it
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and I actually don't want to be a donor
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anymore. Right?
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>> Um, or if you weren't a donor, you could
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say, oh, you know what? I think I will
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register.
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>> And one of the things we found is that
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folks were dramatically, I mean, like 30
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times more likely to add themselves to
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the registry than remove themselves. Um
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and so you know what that meant to us
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was that look when you say you want to
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be an organ donor it's kind of you know
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you sure you can reflect on it and
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change your mind and there were you know
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I think two people out of the you know
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few hundred who decided they wanted to
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remove themselves but uh that kind of
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decision is stickier like deciding you
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want to be an organ donor it's like
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something that you do and and you're
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unlikely to to change your mind
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>> but if you're not a donor you know you
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may not have thought carefully about it
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when you were first asked you might have
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been rushing through at the DMV. You
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might have kind of or your position
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might have changed. You might have heard
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a story about somebody who got a
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life-saving organ transplant, but you
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haven't been back to the DMV or been
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asked about it. And so, you know, just
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by asking again, we netted, you know,
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many, many more donors uh because we
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were just giving them another chance to
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reflect their preferences.
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>> Jed, great to talk to you. Great work.
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Thank you very much.
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>> Thanks so much for having me.
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>> Thank you. Jud Kessler, professor in
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business, economics, and public policy
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here at the Wharton School.
