Nudge: The Final Edition

by Richard H. Thaler

To begin with, we think that people have drawn the wrong conclusion from that famous Johnson-Goldstein graph. The demonstrably correct conclusion to draw is that defaults have a huge impact on the elicitation of preferences. We have seen evidence to support that conclusion throughout the book, and this example remains one of the best empirical tests of that finding. But it is wrong to conclude that adopting a presumed consent policy and obtaining a low opt-out rate will necessarily save lives. That would be a reasonable conclusion if countries were implementing a hard presumed consent rule, meaning that Families would not need to be consulted. Donor consent would literally be presumed. Such a policy would completely eliminate the time and effort needed to get the permission of Families in a process that is highly time sensitive, as well as remove the risk that Families will block the donation. However, we have found that few if any countries actually implement that policy. To give just one example, in Italy, which is nominally a presumed consent country, the official website says this about the role of Families (our translation): “In the case in which the deceased person did not leave a statement regarding organ donation, the donation of an organ is allowed only if the relatives (in order: spouse, partner, adult children, and parents) are not opposed to the donation. For minors, it is always the parents who decide; if even one of the two is against, the donation will not t...