Can Defaults Save Lives? – The Power of Default Options on Life-Saving Decisions

At least, at first, until your motivation fades and you find yourself going less and less often. After six months, you’re not even thinking about going to the gym anymore — but you still don’t cancel the subscription! It’s hard, it takes time, and it takes energy. So, you keep paying for a subscription you don’t use — and now that the deal has expired you’re even paying full price, just because you don’t want to expend effort. That is the magic of defaults: they’re very effective at leveraging our aversion to extra effort.

Understanding the power of defaults, co-authors Johnson and Goldstein (2003) designed a study¹ aimed at promoting organ donation. At any given time, hundreds or thousands of people will be waiting for suitable (and life-saving!) organ donations. As such, it is important for policy-makers to understand the main factors that determine donation rates. The first factors that may come to mind are a person’s religion or her economic and educational status. Yet, reviewing the empirical evidence, these factors failed to explain differences in organ donation rates between countries and localities. Thinking outside the box, the authors wondered how countries’ default policies toward organ donation — i.e., whether people are automatically listed as organ donors with an option to opt-out, or vice versa — might affect propensity to donate. Thus, the present study was designed.

Specifically, the study aimed to answer the following question: can a change in the default policy for organ donation in a country increase the number of people who actually donate? In many countries (including the US), the default option is for people not to donate their organs — though they may change this default by actively choosing to donate. If this were reversed, and, by default, people were enlisted to donate their organs unless they explicitly opted out, would that increase the number of donations vis-à-vis the alternative system?

Methodology: To study the effect of defaults on donation agreements, the researchers looked at the real donation rates in European countries with either opt-in or opt-out default regimes.

Results: The below depicts real donation rates in European countries depending on their policy:

As can be seen in the above graph, in European countries where opt-out was the default, almost everyone consented to donate their organs. Conversely, in opt-in countries, the agreement rate is about 5 times lower.

Recall that previous research failed to identify personal factors that could explain variation in donation rates. By comparison, defaults offer a powerful explanation for disparities in propensity to donate. Defaults have a huge influence on behavior, and setting a default wisely really can save lives.

Legacy: After about 17 years, the results of this study still hold. Beyond simple inertia, others have noted how defaults frame our understanding of the options at hand.² People tend to consider the default policy as a type of norm. Accordingly, opting out of organ donation not only requires effort, it carries a negative perception — in a society where it is common for citizens to participate in a selfless, meaningful deed, I am explicitly stating (even if only privately, to myself) that I won’t be as altruistic as those around me.

Takeaway: When it comes to designing policy, decision-makers need to be mindful of how default settings create a path of least resistance, one that is likely to have a powerful influence on people’s choices. Opting for a different path requires people to overcome their inertia, and also to oppose what may be viewed as a societal norm. Defaults must, therefore, be selected wisely, with a mind toward achieving the best societal outcome. Of course, in so doing, every effort must be made to ensure that opting out of that default (whatever it is) is made as easy and smooth as possible. The result of such a design is a more efficient system that helps society achieve its collective goals while still retaining individuals’ rights to decide for themselves.