Michigan State University, East Lansing, 48824, USA.
Am J Bioeth. 2012;12(2):32-9. doi: 10.1080/15265161.2011.634484.
Richard Thaler and Cass Sunstein (2008) contend that mandated choice is the most practical nudge for increasing organ donation. We argue that they are wrong, and their mistake results from failing to appreciate how perceptions of meaning can influence people's responses to nudges. We favor a policy of default to donation that is subject to immediate family veto power, includes options for people to opt out (and be educated on how to do so), and emphasizes the role of organ procurement organizations and in-house transplant donation coordinators creating better environments for increasing the supply of organs and tissues obtained from cadavers. This policy will provide better opportunities for offering nudges in contexts where in-house coordinators work with families. We conclude by arguing that nudges can be introduced ethically and effectively into these contexts only if nudge designers collaborate with in-house coordinators and stakeholders.
理查德·泰勒和卡斯·桑斯坦（2008 年）认为，强制性选择是增加器官捐赠的最实用的推动手段。我们认为他们错了，他们的错误源于未能理解意义的感知如何影响人们对推动的反应。我们赞成默认捐赠的政策，但要受到直系亲属否决权的限制，包括选择退出的选项（并接受如何退出的教育），并强调器官采购组织和内部移植捐赠协调员在创造更好的环境以增加从尸体获得的器官和组织供应方面的作用。这项政策将为内部协调员与家庭合作的情况下提供更多提供推动的机会。我们的结论是，只有在推动设计者与内部协调员和利益相关者合作的情况下，才能在这些情况下以合乎道德和有效的方式引入推动。
