Behavioural Economic Nudge Policy, Organ-Donation and Heart Transplant Conversion Rates in Alberta, Canada. A Ten-Year Retrospective Analysis

Abstract

Purpose The Canadian Province of Alberta has no presumed consent for organ- donation, and has had chronically low deceased-donation rates. To address this, the government sponsored a public organ-donation registry, which was launched in 2013. Registration was encouraged by using a behavioural economic “nudge”, of prompted choice to enrol at driver's license renewal. We determined the effect of this nudge policy on heart donation rates, and the relative production efficiency of heart transplants (HTx) in Alberta over 10 years, spanning this policy change. Methods Retrospective analysis of administrative and medical transplant databases was conducted from 01/2007 to 12/2016, using interrupted time-series measures of quarterly recipient listings, heart organ offers and transplants. The baseline period 2007-2013 served to reconstruct the counterfactual after the policy rollout. Heart offers were designated by source of origin. Time-related changes were assessed using linear regression, and HTx efficiency was plotted quarterly, using a simple production-frontier model. Results 451 unique individuals were listed for HTx, while 2661 donor heart offers were made from all sources, including 439 (16.5%) from within Alberta. HTx occurred following 306 offers, a conversion rate of 11.5%. Simultaneously, 68 listed patients (15.4%) died while awaiting HTx. A time related 41% increase in donor heart offers from 59.2 to 83.7 per quarter (p Conclusion Nudge policies to increase organ donation did not result in an early increase in the population adjusted heart organ donation rate within Alberta. Improved efficiency in the use of organs offered, rather than increased donor organ numbers may be present the greatest opportunity to improve HTx completion in Alberta.