Underlying Wishes and Nudged Choices

Is the inferred preference of a deceased relative to donate his or her organs stronger when the choice was made under a mandated rather than under an automatic default (i.e., nudged choice) legislative system? The answer to this is particularly important, because families can, and do, veto the choices of their deceased relatives. In three studies, we asked American and European participants from countries that have either a default opt-in or a default opt-out system to take on the role of a third party to judge the likelihood that an individual's true wish was to actually donate his or her organs, given that the decedent was registered to donate on the organ donation register. In each study participants were randomly assigned to one of four organ donation legislative systems (default opt-in, default opt-out, mandated choice, mandatory). Overall, regardless of which country participants came from, they perceived the donor's underlying preference to donate as stronger under the default opt-in and mandated choice systems as compared with the default opt-out and mandatory donor systems. We discuss the practical issues that result from using default systems in the domain of organ donation and propose potential ways to ameliorate the uncertainty around inferences of underlying preference from a nudged choice.