How to save a life

What's the issue?

We take for granted having a heart capable of pumping blood around our body, lungs to help us breathe and a healthy liver to help us digest. But what about the thousands out there without this luxury? Who can they turn to for help? Over 7,000 on the UK transplant waiting list today (NHS, 2017) are sat waiting for their superhero to come save their life!

The National Organ Donor Database was created in 1994, a long time after the first successful organ transplant in 1954 (Hakim & Stratta, 2010). As the UK runs an opt-in system this means people wishing to donate their organs after they die have to sign up to the register. Therefore, it is of even greater importance than in other countries with an opt-out policy to create awareness. This significance increases as the UK currently has one of the lowest organ donation consent rates in Europe and on average 3 people die every day waiting for a transplant (NHS, 2017).

Organ donation has done a lot of good, with over 50,000 people alive today thanks to transplants (Neuberger, Trotter & Stratton, 2017). We have so much further to come though and so many more lives to save! Although 82% of the population say that they definitely want to donate or would consider donating their organs, only 35% of people across the UK have joined the NHS Organ Donor Register (NHS 2016).

Young people have been highlighted this year as ‘changemakers’ by the NHS, who can help spread awareness and get more people signing up to the register. Although individuals cannot donate without family consent before they are 18, they can help stimulate discussion and debate in a family to get people talking. This highlights the importance of getting the word out that everyone can be a hero and one donor can save up to 9 lives (NHS, 2017)!

What we did:

We decided to focus our efforts within an environment we knew and so the target audience was students and staff at the University of Warwick. Our aim here was to get as many people to sign up get their name put on the NHS organ donor register. First port of call was to contact the NHS organ donation publicity team to ask for help and grab as many freebies as we could. They kindly provided us with boxes and boxes of pens, trolley tokens, t-shirts, wristbands, pamphlets and posters (goes to show what just asking for help can get you!). After obtaining permission from our Student Union, we set up a stall to spread the word. Thanks to the NHS’s easy-to-use website we could get people registered on the spot in under 5 minutes!

On top of this, we put posters up all over campus in the weeks leading up to our stall to expose the students to our cause. Some of the posters were set up in the shape of heart to catch the audience’s eye and hopefully get them to stop and read what was to be said.

We also used social media platforms to increase engagement and to let the student body where we would be and what we were doing to reach out to an even wider audience than just passers-by. What student doesn’t love a good excuse for procrastination from working anyway? In our opinion signing up to maybe save a life is a much better use of time than completing yet another buzzfeed quiz!

Persuasion techniques used:

So, we started off with the simplest technique in the book…the ‘just ask’ principle. This idea is based on a study by Clark and Hatfield (1989), showing that sometimes all that’s needed to get people to comply with a request is asking them straight up! In their study the surprising majority of men agreeing to go to bed with a random woman when approached! Therefore, it seemed a good place to start by simply going up to people and asking if they wanted to sign up to be an organ donor.

To make it even harder for people to say no we added a level of commitment by employing the ‘foot in the door’ strategy (Freedman & Fraser, 1966). We got people to comply to a small request, taking an information booklet, so that they would then be more likely to comply to the larger request of signing up to the register. This idea is based on people’s desire to be consistent with what they have already done.

Getting into the actual content of the message, the YALE model of attitude change (Hovland, Janis & Kelley, 1953), looks at what conditions are required to get people to change attitudes following a persuasive message. These conditions are based around the source of the message, the message itself and the recipient. The source component of the model shows us who is likely to create greater influence. Relevant to our project here is the nature of the credibility of the source. Statistics were used from the latest NHS Blood and Transplant statistics report as well as posters, freebies and t-shirts being gained for the stall from the NHS campaign catalogue. The National Health Service (NHS), is the publicly funded national system of healthcare providing services in the UK. Established in 1948 and since employing 1 in 23 of the population (White, 2010), the source credibility is high. The influence of source credibility can be related back to people’s need to be right and by relying on a trustworthy source to influence their decision to sign up to donate their organs or not this is rewarding in helping them achieve their goal of feeling correct (Hovland & Weiss, 1951).

The elaboration likelihood model (Petty & Cacioppo, 1986), is based on the YALE approach. It explains how there isn’t a ‘one size fits all’ theory of behaviour change and two routes can be taken to result in the same attitudinal change. The central route requires motivation and ability to pay attention to the message, whilst the peripheral route uses heuristics and a shallower processing of the message. Ideas taken from the YALE model’s audience component are of key importance here. When looking at a student target population, signing away your organs to be donated after you die may be of little importance to them as they are unmotivated to think about something that would hopefully be far away in the future. This puts them along the peripheral route suggesting cues such as source credibility, as previously mentioned, are key to push! As far as the message content goes, studies have found that statistical evidence messages were better at enhancing both peripheral and central routes for processing information on organ donation, as opposed to narrative examples which only enhanced peripheral processing (Kopfman, Smith, Ah Yun & Hodges, 1998). This shows that by applying statistics rather than narrative persuasive messages this would be more influential for students both with and without the motivation to change their attitude to organ donation.

Presenting the message not only with the right ingredients of credibility and statistics, but also in the right format is important. A message can either be framed in a gain frame; ‘you could save 9 lives’, or a loss frame; ‘9 people could die without your help’. Research has found that when getting people to sign up to become organ donors, a gain frame is the best form of persuasion (Reinhart, Marshall, Feeley & Tutzauer, 2007). Therefore, we used posters that gave a positive approach to showing how many people an individual could help and how lives could be changed for the better.

The groundwork to getting people to change their behaviour and sign up to the donor register started long before the actual day we held our stool. It was important here to get people to start thinking about the idea early so that it sticks in their mind and when it comes down to actually being asked to act they will be more likely not to hesitate. This is the foundation of the availability principle (Tversky & Kahneman, 1973), referring to how when something is more easily recalled form memory it is more likely to be seen as important. We brought this into play by putting up posters around campus sent from the NHS that highlighted becoming an organ donor as an important issue. This also builds on Zajonc’s (1968) mere exposure effect, stating that the more we become familiar with a message, the more we grow to like it and the more likely we will be influenced by it. Therefore, the build-up of the campaign and spreading the word subtlety through posters seemed a simple but effective way to plant the idea in people’s head that they could save a life and donate an organ.

Now what campaign would be complete without a freebie…or ten? ‘Freebie’ is the true buzzword of anyone studying behaviour change and there’s no greater population than debt-ridden students to get this technique to work on. The principle of reciprocity is put to work here with people feeling they need to give something back in return for you giving them something too (Cialdini, 2007). A bright pink pen in return for an organ may seem a stretch but sure enough it worked a treat! On top of this, it’s a great way to attract people to your stall and get them talking.

Finally, we wanted to make sure people turned this desire to want to sign up into the actual behaviour. To do this we turned to the Theory of Planned Behaviour (Azjen, 1991), and it’s 3 components leading to action. Firstly, subjective norms were shown to individuals through displaying statistics of how many people were on the donor register already but also through the social proof of watching others sign up. Furthermore, the attitude towards the behaviour had to be changed so people knew exactly what signing up meant (after we quickly learnt it wasn’t obvious that it was post-death). This was done by handing out information booklets and reducing the fear of having to do anything in the near future. Furthermore, self-efficacy has to be instilled so people really believe they can change their behaviour if they want to sign up. On a basic level this was done by having a laptop present and showing individuals how in under 5 minutes, right there and then, they could become a donor! Simple right? Well not everyone believes it’s their own choice to make this decision and for some their religion may inhibit this. To tackle this, we had booklets on hand stating the dos and don’ts for organ donation for every major religion.

Using the behavioural change techniques discussed above we aimed to create a small change in people’s behaviour (to sign up) which could have a huge effect for many people’s lives! Overall, we managed to get a total of 47 people to sign up for organ donation, saving a possible 423 lives! Whilst changing the behaviour of under 50 people may from the outlook seem insignificant the hundreds of families who could be kept from losing a loved one would disagree!

If you are reading this and would also like to become a true superhero and possibly save a life like the 47 kind people in our study, then please go online and sign up to the organ donation register by following the link below:

https://www.organdonation.nhs.uk/register-to-donate/register-your-details/

by Kate Jones, Robert Lindley and Mike Eccleston

References:

Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50, 179-211.

Cialdini, R. B. (2007). Influence: The psychology of persuasion. New York: Collins

Clark, R. D., & Hatfield, E. (1989). Gender differences in receptivity to sexual offers. Journal of Psychology & Human Sexuality, 2, 39-55.

Freedman, J. L., & Fraser, S. C. (1966). Compliance without pressure: the foot-in-the-door technique. Journal of personality and social psychology, 4, 195.

Hakim, N. S., & Stratta, R. J. (Eds.). (2010). Pancreas, islet and stem cell transplantation for diabetes. Oxford university press.

Hovland, C. I., Janis, I. L., & Kelley, H. H. (1953). Communication and persuasion; psychological studies of opinion change.

Hovland, C. I. & Weiss, W. (1951). The influence of source credibility on communication effectiveness. Public Opinion Quarterly, 15, 635-650. 

Kopfman, J. E., Smith, S. W., Ah Yun, J. K., & Hodges, A. (1998). Affective and cognitive reactions to narrative versus statistical evidence organ donation messages.

Neuberger, J., Trotter, P., & Stratton, R. (2017). Organ transplantation rates in the UK.

NHS Blood and Transplant (2017). Transplant. Statistics and Clinical Audit: NHS Blood and Transplant Organ Donation and Transplantation Activity Report 2016/17.

NHS Blood and Transplant (2016) A Guide for Promoting Organ Donation. Retrieved from: https://nhsbtdbe.blob.core.windows.net/umbraco-assets/1532/nhsbt_a-campaign-guide-for-promoting-organ-donation_nov2016.pdf 

Petty, R. E., & Cacioppo, J. T. (1986). The elaboration likelihood model of persuasion. In Communication and persuasion (pp. 1-24). Springer New York.

Tversky, A., & Kahneman, D. (1973). Availability: A heuristic for judging frequency and probability. Cognitive psychology, 5, 207-232.

White, T. (2010). A Guide to the NHS. Radcliffe Publishing.

Zajonc, R. B. (1968). Attitudinal effects of mere exposure. Journal of personality and social psychology, 9, 1.