Promoting Organ Donation: the Story Behind the Story
(and why asking that dumb question may be the smartest thing you can do)
by Mike Walker • July 21, 2014
In their new book Think Like a Freak, Stephen Dubner and Steve Levitt pose an interesting question: what are the three hardest words to say in the English language?
“I love you,” and “I was wrong” were undoubtedly serious contenders, but the authors settle on three words that we very rarely hear, especially in our professional lives: “I don’t know.” Professor Amanda Waterman, a developmental psychologist at the University of Leeds, has documented children’s unwillingness to say “I don’t know” in numerous studies. Apparently, it’s a habit that we never outgrow as adults. And if you think about it, our educational system—from kindergarten right up through graduate school—conditions us to provide answers, even when we really have none. We’ll take a guess, make stuff up, or fake it—all to avoid saying “I don’t know.”
Here’s the good news: because we hear these three words so rarely, they’re valuable. They’re like the rare earth metals of our business vocabulary, and here’s why: by acknowledging that we may not know the answer, we give ourselves permission to ask questions. By asking questions, we open ourselves up to learning.
My firm helps clients achieve large-scale human behavior change. We spend every day trying to figure out why groups of people do what they do—and how to get them to do something else. With 25+ years of experience under our belts, it’s tempting to make predictions about what will work and what won’t. But just about every single time we’ve set aside our initial assumptions about the answers—saying, in effect, “we don’t know”–we’ve learned something powerful. Let me give you a specific example.
A number of years ago, the US Dept. of Health and Human Services (HHS) asked us to help increase organ donation. Recent advances in surgical medicine had made it possible to save many more lives, but a shortage of donors was making such lifesaving surgeries rare. The solution, according to the prevailing wisdom at the time, was to boost the number of people who checked the “Organ Donor” box on their driver’s license. In fact, several countries achieved this goal with a very simple, but clever change: they “presumed consent.” In other words, citizens are presumed to be consenting donors, but they have the opportunity to register their unwillingness to donate. Unwilling donors must, in effect, “uncheck” a box on their driver’s license. (Richard Thaler and Cass Sunstein refer to this strategy as “opt-out” vs. “opt-in” in their book Nudge, which I highly recommend.)
But here’s the part of the story you probably never heard: while “opt-out” rather than “opt-in” undoubtedly helped increase the number of potential donors, it’s not what increased actual organ donation in the U.S. The team at HHS challenged the prevailing wisdom, and looked beyond driver’s licenses for answers. In other words, they had the good sense to say those 3 words: “we don’t know,” which is why they decided to interview emergency room doctors. What they learned was startling: the organ donor checkbox on a driver’s license almost never influences an organ donation decision. According to physicians, most potential donors arrive at the ER without a driver’s license. Instead, the wishes of surviving family members are the driving factor behind actual organ donations.
Armed with this insight, we adopted an entirely new strategy, and developed the first national social media campaign for enrolling organ and tissue donors online. When donors enrolled on the HHS website, they were able to quickly and easily email friends and family about their decision to become a donor.
To solve particularly challenging problems, we need to ask the seemingly obvious questions. We can only start to do so by acknowledging, “I don’t know.”
I’ll close with a great quote: “Uncertainty is a sign of humility, and humility is just the ability or the willingness to learn.” Know who said that? Say those three words, because I’m willing to bet you don’t know…
…it was Charlie Sheen. (Who knew?)