News Release 

New study warns of misinformation about opt-out organ donation

University of Nottingham

A new study has warned of the power of a type of behaviour dubbed the 'lone wolf' effect which could result in people 'opting out' of supporting organ donation.

A behavioural study led by researchers from the University of Nottingham's School of Psychology and Nanyang Technological University's Department of Economics found that initial co-operation, encouraged by an opt-out policy, can be undermined by members of the public observing the actions of 'lone wolves'.

The study revealed that lone wolves unilaterally defect and publicly display their decision to opt out leading others to follow suit and do the same. This effect of lone wolves is a stronger social force for change than people following 'good shepherds' who are observed to register under an opt-in policy. Their findings have been published in Scientific Reports.

It has long been recognised that when it comes to making an organ donation decision, not everyone wishes to or can donate. People also may wish to donate, but don't, simply because they never got around to signing up. To help overcome this inertia, and redress the shortage in organs, some countries, including Wales and most recently, England, have introduced a change in law, to move from an opt-in system (where everyone is assumed to be a non-donor and registers to be a donors) to an opt-out system (where everyone is assumed to be a donor, unless they opt out.)

The policy in England is a so-called "soft opt-out" policy. This means that all adults in England (unless they are in one of the excluded groups), will be considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate (either by registering their decision on the NHS Organ Donor Register or telling their family and friends.) The system is a "soft opt-out" as relatives will still be consulted, before organ donation goes ahead.

Professor Eamonn Ferguson from the University of Nottingham said: "The opt-out system relies on people accepting the default of their organs being donated, unless they take action to confirm their decision not to donate. However, our research uncovered a disruptor to this called the 'lone wolf'.

If people know that others have decided to opt out, they are very likely also to do the same. In a world dominated by social media and instant messaging, this can sets up a negative cascade that quickly spreads.

This is important as much of the evidence for moving to opt-out is derived from population studies that cover time periods prior to the social media explosion."

The researchers devised economic games to model the organ donor decision. 213 people participated in games where they indicated their decision to register as a donor under opt-in, or opt-out. They examined the effect the feedback from others (akin to social media updates) had on people's decisions.

Associate Professor Jonathan Tan of Nanyang explains: "In theory, under an opt-out system where feedback is available, people are better off cooperating if they cannot get away with free-riding since others can observe them and opt out too. In practice, however, so long as there are lone wolves who unconditionally free-ride, this default system will lose its strategic power."

Professor Ferguson adds: "The results showed that when people decide not to follow an opt-out default or request, the effect on causing others to follow suit is very strong and much stronger than following people who are acting in accordance with an opt-in policy and registering.

We know that people follow others behaviour, but it is interesting that when everyone is requested to cooperate and help, people has a strong tendency to follow the example of a negative uncooperative influence (or lone wolf). Many people may decide to opt-out simply because others do. This may be because they think that others know something they don't or they don't want to be left behind.

This also raises a very real risk that incorrect information about organ donation and the law change could lead large numbers of people to opt out. This is something that has not been documented before in academic research and we feel is important for the public to be aware, so they can be alert and on their guard for the influence of such information.

While we examined these effects in organ donation they have implications for other public health policies where defaults may be considered such as vaccinations, energy conservation and social distancing."

We would recommend harnessing the 'good shepherd' effect to help encourage registration as exemplified by recent evidence that posting about signing up to be a donor increased registration: the so called 'Facebook' effect.

If moving to an opt-out policy then strategies to ameliorate the 'lone wolf 'effect need to be considered. This could involve the use of moral norms to ameliorate the 'lone wolf 'as well as strategies to monitor social media and 'fake news' or negative stories about organ donation and ask people to question the validity of any information they see."

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