Saving lives: would you do it? Explaining a world without donors

Denmark had a grave problem. Being a highly developed country, educated and with life quality levels that any other country would envy, its citizens were dying every day due to the lack of organ donors. Only 4,25% of the population was registered as a donor. Uncountable campaigns, education programs, propaganda… nothing worked out. Sweden reached an 85,9% of donor population; cultural factors were then ruled out as a possible cause. When the researchers at the “Center for Decision Sciences” of the University of Columbia begun looking for the deep reasons, they found truly surprising and unexpected motives, which let in evidence the flaws present in reason and will.

The case of the Bella Valentina, who suffers from cystic fibrosis has shaken social networks. Her life could be extended if 3 of her organs could be transplanted. Her story has moved the entire world, by demanding eutanasia to the president herself; I don’t know anyone who wouldn’t choose voluntarily to give their organs up for this girl when they die. However, there are people dying every day and there are no organs.

We can agree that many are the factors that influence the motivation for donating organs when dying: religion, culture, education, death-related experiences, social values or even the myth that being a donor will make doctors less willing to save you. Outstanding is what surveys show when compared to reality. At least 50% of US citizens approve of organ donation; yet, only 25% have taken any action related to it. In the Netherlands, a vast majority approves of this practice but no one exercises it and, in an extreme measure, the government has sent a letter to each and every one of the households begging for their inscription in the donor programs: they only convinced 28% of the population. In the UK, only a 17,2% is a donor and, in Germany, not even 12%

Around this figures several explanations have been considered, from the harshest economy like: “the moral benefit that arises from the decision of being a donor is not much higher than its cost, then no one wants to donate”, up to the extreme left sociology: “the neoliberal system has generated such a degree of individualism that no one is interesting in saving lives”. These explanations make some sense, but are wrong; and when we examine what is at stake, not donating seems extremely opposed to common sense. “Would you accept that, when you die, your operative organs were used to save the life of children, adults or even a relative of yours? If you say no, we will respect you and your organs shall decompose under the ground.”

The Danish government correctly invited the researchers of the University of Columbia to find out the causes of this strange behaviour. Eric Johnson and Dan Goldstein performed an exhaustive analysis from the propaganda donation programs up to the school education practices and even personal interviews on the matter. Nothing would explain successfully the 4,25% of donors. When there was almost nowhere else to go, they decided to look directly at the source: when and where did people decide to be or not to be a donor? When analysing the driver licences they found the unbelievable.

On a sample of a low 15,2% of donors on average, made up of Denmark, Netherlands, UK and Germany, the consent form asked the driver the following: “Please check the box if you wish to participate in the donor program.” Unlike the second set of countries, with a 97,6% of donors, with Austria, Belgium, France, Hungary, Poland, Portugal and Sweden, the drivers were asked: “Please check the box if you do NOT wish to participate in the donor program.”

In both cases, almost no one checked the box. Several hypothesis have been considered regarding this phenomenon, again with the harshest economists and their moral cost being higher than its benefit. However, from the economy of behaviour and emotions we believe it is quite the contrary: people care so much that, when facing the hard, overwhelming and unpleasant decision, they paralyse and decide not to make a choice instead of beginning a long internal dialogue. They even decide willingly to postpone their decision: “I will investigate and then make a choice”, and that is how all forms end up blank, regardless of the question.

These causes belong to a more humane field than the mere rational analysis of the problem. People were, in general, okay with donating; yet, when facing the decision-making moment and being added to the program, the overwhelming emotion, related to fear and uncertainty paralysed their action.

Uncountable examples exist of situations in which we are free to choose, reason and will seem to prime and yet the final result does not belong to the values we agree with. Blaise Pascal said that there are two excesses: “excluding reason and not accepting anything but it”, and great wisdom shall we find on his words. The case of the Bella Valentina and her fibrosis is not trivial; in fact it is quite representative of a world in which people die due to the lack of donors. Our ability to rationally choose is blocked by the overwhelming intensity of emotions in these situations. For those who dream of becoming superheroes and having superpowers, I invite you to live donations as a love dogma, service to the others, and gratitude. How noble the legacy of giving life. The opportunity of becoming superheroes and changing someone else’s life comes to us all; when it does, do not hesitate and do it.