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