Post by the BC Behavioural Insights Group
Jurisdictions around the world are making efforts to increase organ donation registration rates in order to increase the number of potential donors. These efforts are by no means trivial. Last year, in British Columbia, Canada, there were more than 500 people on an organ donation waitlist, six of whom, sadly, passed away. By increasing the number of potential organ donors, our chances of saving lives also increase.
In British Columbia, people can register their decision regarding organ donation either online or in person at Service BC centres, which also process driver’s licenses, taxes, income assistance checks, or other government related business. Since 2016, Service BC centres have registered over 100,000 organ donation decisions. In-person registration at Service BC centres decreased during the pandemic, when operations were restricted to prevent the spread of COVID-19. After restrictions were lifted in 2021, Service BC centres continued reporting low numbers of new donor registrations.
As part of their commitment to British Columbians, Service BC, the BC Behavioural Insights Group (BC BIG) and BC Transplant developed and piloted a strategy to bring organ donation registrations back up.
Applying Behavioural Insights to Organ Donation
The strategy comprised three parts:
A workshop with Service BC staff to address psychological barriers they may face when broaching the topic of organ donation with clients, including perceptions of an awkward segue into organ donation talk, desire to be respectful or sensitive to religious views on organ donation, and worry about the need to answer technical questions.
Posters displayed at Service BC centres with messages encouraging clients to register using the message “90% of British Columbians support organ donation, but only 25% are registered as organ donors.”
Handing out an organ donation registration form upon client arrival at the centre. This last component was implemented only at Service BC centres with a welcome desk.
We piloted this approach at eight Service BC centres selected to represent different sizes and customer traffic volumes, and the presence (or absence) of a welcome desk.
A Service BC centre featuring the pilot poster. Photo taken and used with Service BC permission.
What We Found
After nine months, we looked at the percentage of clients who completed and submitted organ donation registration forms during their visit to a Service BC centre.
We compared the percentage of clients who registered across centres that displayed the new posters versus those that did not. We were pleased to discover that the percentage of registrations was five times higher at offices that displayed the poster with the message “90% of British Columbians support organ donation, but only 25% are registered as organ donors.”
We also compared centres with a welcome desk (where registration forms were handed out to clients upon arrival) versus those without a welcome desk (where registrations were made available at service wickets, but not given to clients). We found that the percentage of registrations was three times higher at centres with a welcome desk compared with centres without.
Overall, this means that in all centres, the strategy increased organ donation registrations irrespective of their size, customer traffic volume, and whether they had a welcome desk or not.
How we did it
This project used insights from behavioural science to encourage citizens to register as organ donors and applied rigorous scientific methods to evaluate interventions. This allowed the project team to quantify their impact, thus producing high quality, unbiased, evidence to support decision-making. Our findings provide compelling evidence that a behavioural insights approach in communicating with citizens can effectively support individuals in registering their organ donation decisions.
A lot went into the design and delivery of each of the components of the approach.
To inform the workshop design, we surveyed 40 customer service representatives from Service BC centres on their experiences broaching this topic with the public.
The messages that were considered for the posters were inspired by similar work undertaken in Ontario, the UK, and B.C. These messages were pre-tested with a sample of 239 people to find the two most promising options. These two messages were then embedded in marketing materials designed by BC Transplant’s team.
Lastly, collaboration between all project partners was required to determine how marketing materials should be displayed in the eight participating Service BC centres.
The most challenging aspect of this initiative, and of any behavioural insights project in general, is figuring out the best way to measure the impact of the proposed solution. Looking at differences between decision registration rates before and after these changes were introduced would not allow the team to determine which aspect was effective (the training or the marketing) and could lead to faulty conclusions. After all, an unrelated event (e.g., high profile organ donation case) could be enough to drive more registrations irrespective of the changes we introduced.
To determine the impact of our proposed changes, BC BIG designed a sophisticated evaluation approach that involved introducing the changes progressively across different Service BC centres. Starting in January 2023, Service BC centres implemented the new strategy at two offices per month for four months. That is, on the 1st of January, two offices implemented the changes, on the 1st of February two additional offices implemented the changes, and so on.
The staggered roll-out of the changes allowed the team to modify and adapt the implementation to suit the specific circumstances of each centre and, importantly, to ensure that changes did not interfere with the normal operation of each Service BC centre. These adaptations required collecting additional data so that changes could be accounted for in the analyses. For example, some centres had more space to place posters than others, and the position of the poster in relation to clients could make them more or less visible. Furthermore, customer service representatives at participating centres with welcome desks were directed to hand out organ donation registration forms to clients when greeting them, whereas registration forms were made available, but not physically provided to clients, near service wickets in centres without welcome desks.
The success of the project would not have been possible without the commitment and passion of Service BC’s customer service representatives, who go the extra mile when it comes to a good cause like organ donation. They were the ones who made this project happen. Of course, the same goes for all the Service BC and BC Transplant project team members, whose support and collaborative disposition took us to the finish line.
How Many Lives Might We Save?
We estimate that Service BC will see, on average, 2,013 new organ donation registrations per year if all centres display the poster with the message “90% of British Columbians support organ donation, but only 25% are registered as organ donors.” If the 13 centres that have a welcome desk hand out registration forms upon client arrival, we can expect to see an estimated additional 449 registrations per year. In doing so, we hope fewer people will not have to wait for a life-saving transplant, let alone pass away while waiting.
You can do your part by registering to be an organ donor here or by verifying you are already registered here.