Can the general public learn to deal with risk and uncertainty, or do authorities need to steer people’s choices in the right direction? Libertarian paternalists argue that results from psychological research show that our reasoning is systematically flawed and that we are hardly educable because our cognitive biases resemble stable visual illusions. For that reason, they maintain, authorities who know what is best for us need to step in and steer our behavior with the help of “nudges.” Nudges are nothing (...) new, but justifying them on the basis of a latent irrationality is. In this article, I analyze the scientific evidence presented for such a justification. It suffers from narrow logical norms, that is, a misunderstanding of the nature of rational thinking, and from a confirmation bias, that is, selective reporting of research. These two flaws focus the blame on individuals’ minds rather than on external causes, such as industries that spend billions to nudge people into unhealthy behavior. I conclude that the claim that we are hardly educable lacks evidence and forecloses the true alternative to nudging: teaching people to become risk savvy. (shrink)

The paper shows why and how an empirical study of fast-and-frugal heuristics can provide norms of good reasoning, and thus how (and how far) rationality can be naturalized. We explain the heuristics that humans often rely on in solving problems, for example, choosing investment strategies or apartments, placing bets in sports, or making library searches. We then show that heuristics can lead to judgments that are as accurate as or even more accurate than strategies that use more information and computation, (...) including optimization methods. A standard way to defend the use of heuristics is by reference to accuracy-effort trade-offs. We take a different route, emphasizing ecological rationality (the relationship between cognitive heuristics and environment), and argue that in uncertain environments, more information and computation are not always better (the “less-can-be-more” doctrine). The resulting naturalism about rationality is thus normative because it not only describes what heuristics people use, but also in which specific environments one should rely on a heuristic in order to make better inferences. While we desist from claiming that the scope of ecological rationality is unlimited, we think it is of wide practical use. (shrink)

If citizens’ behavior threatens to harm others or seems not to be in their own interest, it is not uncommon for governments to attempt to change that behavior. Governmental policy makers can apply established tools from the governmental toolbox to this end. Alternatively, they can employ new tools that capitalize on the wealth of knowledge about human behavior and behavior change that has been accumulated in the behavioral sciences. Two contrasting approaches to behavior change are nudge policies and boost policies. (...) These policies rest on fundamentally different research programs on bounded rationality, namely, the heuristics and biases program and the simple heuristics program, respectively. This article examines the policy–theory coherence of each approach. To this end, it identifies the necessary assumptions underlying each policy and analyzes to what extent these assumptions are implied by the theoretical commitments of the respective research program. Two key results of this analysis are that the two policy approaches rest on diverging assumptions and that both suffer from disconnects with the respective theoretical program, but to different degrees: Nudging appears to be more adversely affected than boosting does. The article concludes with a discussion of the limits of the chosen evaluative dimension, policy–theory coherence, and reviews some other benchmarks on which policy programs can be assessed. (shrink)

What is the nature of moral behavior? According to the study of bounded rationality, it results not from character traits or rational deliberation alone, but from the interplay between mind and environment. In this view, moral behavior is based on pragmatic social heuristics rather than moral rules or maximization principles. These social heuristics are not good or bad per se, but solely in relation to the environments in which they are used. This has methodological implications for the study of morality: (...) Behavior needs to be studied in social groups as well as in isolation, in natural environments as well as in labs. It also has implications for moral policy: Only by accepting the fact that behavior is a function of both mind and environmental structures can realistic prescriptive means of achieving moral goals be developed. (shrink)

It has recently been argued that successful evidence-based policy should rely on two kinds of evidence: statistical and mechanistic. The former is held to be evidence that a policy brings about the desired outcome, and the latter concerns how it does so. Although agreeing with the spirit of this proposal, we argue that the underlying conception of mechanistic evidence as evidence that is different in kind from correlational, difference-making or statistical evidence, does not correctly capture the role that information about (...) mechanisms should play in evidence-based policy. We offer an alternative account of mechanistic evidence as information concerning the causal pathway connecting the policy intervention to its outcome. Not only can this be analyzed as evidence of difference-making, it is also to be found at any level and is obtainable by a broad range of methods, both experimental and observational. Using behavioral policy as an illustration, we draw the implications of this revised understanding of mechanistic evidence for debates concerning policy extrapolation, evidence hierarchies, and evidence integration. (shrink)

Loss aversion can occur in riskless and risky choices. We present novel evidence on both in a non-student sample (660 randomly selected customers of a car manufacturer). We measure loss aversion in riskless choice in endowment effect experiments within and between subjects and find similar levels of average loss aversion in both. The subjects of the within study also participate in a simple lottery choice task which arguably measures loss aversion in risky choices. We find substantial heterogeneity in both measures (...) of loss aversion. Loss aversion in riskless choice and loss aversion in risky choice are strongly positively correlated, but on average riskless loss aversion is higher than risky loss aversion. We find that in both choice tasks, loss aversion increases in age, income, and wealth, and decreases in education. Our results provide novel supportive input to the debate about the reality of loss aversion. (shrink)

An effective method to increase the number of potential cadaveric organ donors is to make people donors by default with the option to opt out. This non-coercive public policy tool to influence people’s choices is often justified on the basis of the as-judged-by-themselves principle: people are nudged into choosing what they themselves truly want. We review three often hypothesized reasons for why defaults work and argue that the as-judged-by-themselves principle may hold only in two of these cases. We specify further (...) conditions for when the principle can hold in these cases and show that whether those conditions are met is often unclear. We recommend ways to expand nationwide surveys to identify the actual reasons for why defaults work and discuss mandated choice policy as a viable solution to many arising conundrums. (shrink)

In this paper we provide a critical discussion of how the most progressive parental leave policies are doing with respect to three goods which we identify as essential for liberal egalitarian feminists interested in parental leaves: the good of parental care, the good of gender fairness, and the good of individual choice. Then we offer our own model, based on the power of defaults, which promotes the goods of parental care and gender justice by sacrificing as little as possible of (...) the good of individual choice. (shrink)

Nudging works through dispositions to decide with specific heuristics, and has three component parts. A nudge is a feature of an environment that enables such a disposition; a person is nudged when such a disposition is triggered; and a person performs a nudged action when such a disposition manifests in action. This analysis clarifies an autonomy-based worry about nudging as used in public policy or for private profit: that a person’s ability to reason well is undermined when she is nudged. (...) Reasoning well is a component of self-guidance, which is an aspect of autonomy and so something there is reason to promote, preserve, or respect. However, a person can reason well when she is nudged: Many of these heuristics are good rules to reason with, and she can be flexible with respect to them when she takes there to be a better way to reason. Along the way, this paper uncovers several design specifications for responsible nudging, and discusses open empirical questions. However, nudging’s being compatible with reasoning well crystallizes a distinct worry about manipulation: that nudge designers can rely on nudged people guiding themselves toward the designers’ own ends. Manipulation of this sort exploits one aspect of autonomy (namely, self-guidance) to undermine autonomy in other respects. (shrink)

The ethical dilemma of whether autonomous vehicles should protect the passengers or pedestrians when harm is unavoidable has been widely researched and debated. Several behavioral scientists have sought public opinion on this issue, based on the premise that EDs are critical to resolve for AV adoption. However, many scholars and industry participants have downplayed the importance of these edge cases. Policy makers also advocate a focus on higher level ethical principles rather than on a specific solution to EDs. But conspicuously (...) absent from this debate is the view of the consumers or potential adopters, who will be instrumental to the success of AVs. The current research investigated this issue both from a theoretical standpoint and through empirical research. The literature on innovation adoption and risk perception suggests that EDs will be heavily weighted by potential adopters of AVs. Two studies conducted with a broad sample of consumers verified this assertion. The results from these studies showed that people associated EDs with the highest risk and considered EDs as the most important issue to address as compared to the other technical, legal and ethical issues facing AVs. As such, EDs need to be addressed to ensure robustness in the design of AVs and to assure consumers of the safety of this promising technology. Some preliminary evidence is provided about interventions to resolve the social dilemma in EDs and about the ethical preferences of prospective early adopters of AVs. (shrink)

This essay indicates that Confucian family-based ethics is by no means a stumbling block to organ donation in China. We contend that China should not change to an opt-out consent system in order to enhance donation because a “hard” opt-out system is unethical, and a “soft” opt-out system is unhelpful. We argue that the recently-introduced familist model of motivation for organ donation in mainland China can provide a proper incentive for donation. This model, and the family priority right that this (...) model supports, is ethically justifiable in terms of Confucian family-based ethics. (shrink)

Nudging is a tool of libertarian paternalism. It involves making use of certain psychological tendencies in order to help people make better decisions without restricting their freedom. However, some have argued that nudging is objectionable because it interferes with, or undermines, the rational decision-making of the nudged agents. Opinions differ on why this is objectionable, but the underlying concerns appear to begin with nudging’s threat to rational decision-making. Those who discuss this issue do not make it clear to what this (...) threat to rationality amounts. In this paper I evaluate what effect nudging has on our decision-making and I argue that it does not typically interfere with our rationality in a problematic way. Perhaps nudging is objectionable for other reasons, but we should not argue that nudging is objectionable based on concerns about rational decision-making. (shrink)

Companies often encourage consumers to engage in sustainable behaviors using their services in a more environmentally friendly or green way, such as reusing the towels in a hotel or replacing paper bank statements by electronic statements. Sometimes, the option of green service is implied as the default and consumers can opt-out, while in other cases consumers need to explicitly ask for switching to a green service. This research examines the effectiveness of choice architecture and particularly the different default policies—i.e., the (...) alternative the consumer receives if he/she does not explicitly request otherwise—in engaging consumer green behavior. In four experiments, we show that the opt-out default policy is more effective than the opt-in, because it increases anticipated guilt. This effect is stronger for consumers who are less conscious for the environment.We also show that a forced choice policy, in which the consumer is not automatically assigned to any condition and is forced to choose between the green and the non-green service option, is more effective than the opt-in policy and not significantly more effective than the opt-out policy. Finally, we show that the role of defaults is weakened, if a negotiated cooperation strategy is used. The article contributes to the literature of defaults and provides managerial and public policy implications for the design of green services. (shrink)

Neuromoral theorists are those who claim that a scientific understanding of moral judgment through the methods of psychology, neuroscience and related disciplines can have normative implications and can be used to improve the human ability to make moral judgments. We consider three neuromoral theories: one suggested by Gazzaniga, one put forward by Gigerenzer, and one developed by Greene. By contrasting these theories we reveal some of the fundamental issues that neuromoral theories in general have to address. One important issue concerns (...) whether the normative claims that neuromoral theorists would like to make are to be understood in moral terms or in non-moral terms. We argue that, on either a moral or a non-moral interpretation of these claims, neuromoral theories face serious problems. Therefore, neither the moral nor the non-moral reading of the normative claims makes them philosophically viable. (shrink)

The attempts to mitigate the unprecedented health, economic, and social disruptions caused by the COVID-19 pandemic are largely dependent on establishing compliance to behavioral guidelines and rules that reduce the risk of infection. Here, by conducting an online survey that tested participants’ knowledge about the disease and measured demographic, attitudinal, and cognitive variables, we identify predictors of self-reported social distancing and hygiene behavior. To investigate the cognitive processes underlying health-prevention behavior in the pandemic, we co-opted the dual-process model of thinking (...) to measure participants’ propensities for automatic and intuitive thinking vs. controlled and reflective thinking. Self-reports of 17 precautionary behaviors, including regular hand washing, social distancing, and wearing a face mask, served as a dependent measure. The results of hierarchical regressions showed that age, risk-taking propensity, and concern about the pandemic predicted adoption of precautionary behavior. Variance in cognitive processes also predicted precautionary behavior: participants with higher scores for controlled thinking (measured with the Cognitive Reflection Test) reported less adherence to specific guidelines, as did respondents with a poor understanding of the infection and transmission mechanism of the COVID-19 virus. The predictive power of this model was comparable to an approach (Theory of Planned Behavior) based on attitudes to health behavior. Given these results, we propose the inclusion of measures of cognitive reflection and mental model variables in predictive models of compliance, and future studies of precautionary behavior to establish how cognitive variables are linked with people’s information processing and social norms. (shrink)

While substantial effort has been invested in making robots more reliable, experience demonstrates that robots operating in unstructured environments are often challenged by frequent failures. Despite this, robots have not yet reached a level of design that allows effective management of faulty or unexpected behavior by untrained users. To understand why this may be the case, an in-depth literature review was done to explore when people perceive and resolve robot failures, how robots communicate failure, how failures influence people's perceptions and (...) feelings toward robots, and how these effects can be mitigated. Fifty-two studies were identified relating to communicating failures and their causes, the influence of failures on human-robot interaction (HRI), and mitigating failures. Since little research has been done on these topics within the HRI community, insights from the fields of human computer interaction (HCI), human factors engineering, cognitive engineering and experimental psychology are presented and discussed. Based on the literature, we developed a model of information processing for robotic failures (Robot Failure Human Information Processing, RF-HIP), that guides the discussion of our findings. The model describes the way people perceive, process, and act on failures in human robot interaction. The model includes three main parts: (1) communicating failures, (2) perception and comprehension of failures, and (3) solving failures. Each part contains several stages, all influenced by contextual considerations and mitigation strategies. Several gaps in the literature have become evident as a result of this evaluation. More focus has been given to technical failures than interaction failures. Few studies focused on human errors, on communicating failures, or the cognitive, psychological, and social determinants that impact the design of mitigation strategies. By providing the stages of human information processing, RF-HIP can be used as a tool to promote the development of user-centered failure-handling strategies for HRIs. (shrink)

Recent scholarship in business ethics has revealed the importance of privacy expectations as they relate to implicit privacy norms and the business practices that may violate these expectations. Yet, it is unclear how and when businesses may violate these expectations, factors that form or influence privacy expectations, or whether or not expectations have in fact been violated by company actions. This article reports the findings of three studies exploring how and when the corporate dissemination of consumer data violates privacy expectations. (...) The results indicate that consumer sentiment is more negative following intentional releases of sensitive consumer data, but the effect of data dissemination is more complex than that of company intentionality and data sensitivity alone. Companies can effectively set, and re-affirm, privacy expectations via consent procedures preceding and succeeding data dissemination notifications. Although implied consent has become more widely used in practice, we show how explicit consent outperforms implied consent in these regards. Importantly, this research provides process evidence that identifies perceived violation of privacy expectations as the underlying mechanism to explain the deleterious effects, on consumer sentiment, when company actions are misaligned with consumers’ privacy expectations. Ethical implications for companies collecting and disseminating consumer information are offered. (shrink)

Political egalitarians hold that there is a distinct ideal of political equality, which defines and justifies democracy. So what is political equality? The orthodox view says it is equality of opportunity for political influence, not equality of political influence. The first goal of this article is to argue against this view about the nature of political equality. From 1962 to 1983, Australia’s First Nations citizens had the right to vote, but unlike other citizens they did not have the duty to (...) vote. First Nations citizens were made politically unequal without being given any less opportunity for influence; the most plausible explanation for why they were made politically unequal is instead that they were made to exert less influence. The second goal is to use this challenge to illuminate the point of political equality. The orthodox view is typically undergirded by taking political equality to be concerned with some cosmic injustice that inheres in states of affairs, depending on the distribution of power. This is doubly mistaken. The point of political equality is deontic, not telic; and what it prescribes is not distributive, but relational. More specifically, the point of political equality is for the state to treat each citizen as an equal coauthor of the law. The overarching goal is to catalyze a more vigorous debate about political equality, akin to the long-standing debates about other dimensions of equality. (shrink)

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated (...) at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public. (shrink)

Organ transplantation remains one of modern medicine's remarkable achievements. It saves lives, improves quality of life, diminishes healthcare expenditures in end-stage renal patients, and enjoys high success rates. Yet the promise of transplantation is substantially compromised by the scarcity of organs. The gap between the number of patients on waiting lists and the number of available organs continues to grow. As of January 2006, the combined waiting list for all organs in the United States was 90,284. Unfortunately, thousands of potential (...) organs are lost each year, primarily due to lack of consent to donation from the deceased before death, or from the family thereafter. Only fifty percent of potential donors – the “conversion” rate – become actual donors. The costs attributed to organ shortage are substantial – Medicare paid over $15.5 billion in 2002 for treating patients with end-stage renal-disease, who predominate on organ waiting lists. (shrink)

Surrogates’ decisions to withhold or withdraw life-sustaining treatments (LSTs) are pervasive. However, the factors influencing surrogates’ decisions to initiate LSTs are relatively unknown. We present evidence from two experiments indicating that some surrogates’ decisions about when to initiate LSTs can be predictably manipulated. Factors that influence surrogate decisions about LSTs include the patient’s cognitive state, the patient’s age, the percentage of doctors not recommending the initiation of LSTs, the percentage of patients in similar situations not wanting LSTs, and default treatment (...) settings. These results suggest that some people may use heuristics when making these important life-and-death decisions. These findings may have important moral implications for improving surrogate decisions about LSTs and reconsidering paternalism. (shrink)

One of the largest, oldest, and most interesting challenges in health care is the balancing act in which clinicians have generally uncontroversial duties both to individual patients and to communities. Physicians and nurses must — so we teach them — put patients first, and at the same time recognize that individuals are members of communities. Individuals affect the health of communities, and communities affect the health of individuals. Thus, the moral and professional duties that result are sometimes in conflict.Moreover, the (...) traditional, prosaic clinical encounter is evolving in an environment increasingly shaped by electronic health records, personal health records, pharmacogenomics and vast networks of data collection and storage for public health surveillance, human subjects research, health services evaluation, and comparative effectiveness research. Health information technology is changing everything. It would be perverse otherwise: imagine large amounts of data and information either ignored, missed, or collected and then ignored. (shrink)

Although transplantation surgeries are relatively successful and save the lives of many, only few are willing to donate organs. In order to better understand the reasons for donation or refusing donation and their implications on and influence by public policy, we conducted a survey examining public views on this issue in Israel. Between January and June 2010, an anonymous questionnaire based on published literature was distributed among random and selected parts of Israeli society and included organ recipients, organ donors, soldiers, (...) university and high school students, and the general population. The analysis of 799 questionnaires revealed that, although 74.7 percent have not signed a donor card, 60.8 percent of participants consider doing so. Additionally, 54.3 percent of respondents objected to giving or receiving compensation for donation, and, if at all, priority in transplantation care is the most desired form of such compensation. The health status of the donor and knowing that donation saves lives or that there exists a shortage of organs for transplantation are the two factors most affecting motivation to donate. Lack of information, relatives’ views on donation, and type of organ involved in donation are factors most inhibiting donation. Willingness to donate is significantly affected by the proximity of the recipient to the donor. With regard to most organs, their contribution to one’s sense of “self” and its symbolic role strongly affects motivation to donate, except for donation to relatives. Compensation for organ donation has little effect on motivation to donate during life and after death. Our findings suggest new ways to construct a more effective public policy on this issue. (shrink)

We discuss what makes a “good” environmental nudge from the policy maker’s point of view. We first delineate what is paternalistic about environmental nudges. We then discuss the effectiveness of nudges, including their paradoxical effects on the targeted behaviour, as well as possible collateral effects on the decision-maker’s wellbeing. We also discuss why the libertarian and ethical aspect of nudges may render them more, and not less, attractive as policy instruments and decision aids. We conclude by discussing accuracy and privacy (...) concerns of information-based nudges, and with some recommendations for the design of effective and ethical nudges. (shrink)

Order ethicists favour incentives as a means for making moral progress but largely ignore an alternative method, namely, nudging, which has come to prominence through the work of behavioural scientists in recent years. In this paper, we suggest that this is a mistake. Order ethicists have no reason to ignore nudging as an alternative method. Arguments they might press against it include worries about paternalism, manipulation, autonomy, and unintended bad consequences. These are, we argue, largely unfounded insofar as they involve (...) misconceptions or affect incentives as well. In particular, we contend that only some, but not all, nudges are paternalistic, manipulative, and autonomy-reducing. The same is true of incentives. Also, both nudges and incentives can have unintended bad consequences. Therefore, order ethicists cannot endorse arguments against nudges without undermining their favourable view of incentives. In addition, there might be positive reasons to prefer nudges to incentives, for instance, when they are more freedom-preserving, more effective, cheaper, easier to implement, or less inequality-inducing than the latter. (shrink)

The first question I discuss in this paper is whether we have a duty of rescue to make our organs available for transplantation after our death, a duty we owe to patients suffering from organ failure. The second question is whether political obligations, in particular the obligation to obey the law, can be derived from natural duties, possibly duties of beneficence. Such duties are normally seen as merely imperfect duties, not owed to anyone. The duty of rescue, however, is a (...) perfect one, mainly because it applies to us when we are in a unique position to provide urgent help to a person in need. The basic idea of a natural duty account of political obligation is that such unique positions can be artificially created by institutionalized coordination schemes. The remaining problem is how any particular coordination scheme could claim our allegiance rather than any other. This problem can be solved in different ways in the organ donation case, and in respect to a limited set of political obligations, mainly negative ones. A natural duty account is best seen as a constitutive part of a multiple principle theory of political obligation. (shrink)

In the event that a patient has lost their decision-making capacity due to illness or injury, a surrogate is often appointed to do so on their behalf. Research has shown that people take less risk when making treatment decisions for other people than they do for themselves. This has been discussed as surrogates employing greater caution for others given the accountability they are faced with. We tested the prediction that making accountability salient reduces risk- taking for others relative to the (...) self by manipulating the information shown to participants while they made treatment choices. One group was asked to focus on the consequences for the recipient’s family, another on the legal implications of their decisions, and another was not given additional information. Participants reduced their risk-taking for others compared to themselves, irrespective of the condition they were in. Although participants in each condition reported thinking about these factors to different extents, there were no clear differences in risk-taking between groups. However, we did find that, across all participants, thinking about legal consequences reduces risk-taking. We suggest that future research investigates how the effect of thinking about accountability on surrogate choices is mediated by feelings of accountability, in order to further examine the explanations suggested in the literature. (shrink)

We introduce nudges in order to incite investors to choose Socially Responsible Investment funds instead of traditional funds. We have set up two online experiments with a total of 713 US retail investors, using three types of nudges to elicit their effects on investors’ SRI investments level: making SRI the default investment, introducing a SRI explanation message, and priming ethical values by displaying shocking images. Making SRI the default option is the most efficient nudge to influence investors towards SRI. Its (...) effect is twofold. First, around 50% of investors do not opt-out of the default allocation. Second, even investors who opt-out of the default allocation invest more in SRI than those in the control group, an effect that appears driven by anchoring. Although investors subjected to both priming and message content marginally increase their SRI investment, priming or message content in isolation appears to have a non-significant influence. For choice architects who want to steer retail investors towards SRI funds, making them the default option appears to be the most powerful nudge. (shrink)

Behavioural spillovers refer to the influence that a given intervention targeting behaviour 1 exerts on a subsequent, non-targeted, behaviour 2, which may or may not be in the same domain (health, finance etc.) as one another. So, a nudge to exercise more, for example, could lead people to eat more or less, or possibly even to give more or less to charity depending on the nature of the spillover. But what if spillovers also operate backwards; that is, if the expectation (...) of behaviour 1 influences behaviour 0 that precedes it? For example, a person may form an intention to exercise prompted by a policy intervention but overeat at present as a result. We define such a possibility as a "spillunder". In the proposed article, we critically review the few papers that we have identified through a narrative literature review which have demonstrated spillunder effects to date, and we propose a conceptual framework. Based on evidence about the human mind and behaviour from psychology and economics, we argue that spillunder effects may be more common than the limited empirical findings suggest. We propose six representative mechanisms through which the prospect of behaviour 1 may impact behaviour 0: executive functions, moral licensing and moral cleansing, emotion regulation, energization, construal level, and savouring and dread. We further discuss the policy and practical implications of spillunder effects and examine methodological issues that need to be considered when empirically testing these effects. As with our earlier paper on spillovers, we aim to motivate other behavioural scientists to research behavioural spillunders more systematically and extensively, and to prompt decision makers to consider these effects when designing behavioural interventions. (shrink)

In the early days of organ transplantation from deceased donors, the surgical team would bring the donor into the operating room with the recipient, the respirator would be stopped, and the team would wait for the donor’s heart to cease beating. This type of organ donation has been defined as donation after cardiac death, also referred to as non-heart-beating donation. These donors were not declared dead using neurological criteria, but rather using conventional cardiorespiratory criteria. In 1959, Mollaret and Goulon coined (...) the term “coma dépassé” for the patients with an irreversible state of coma and apnea. Jean Morelle and Guy Alexandre of the Catholic University of Louvain, Belgium, were the first to introduce a set of brain death criteria based on the description of coma dépassé, and carried out, in 1963, the first transplants from a brain dead donor in their country and in the world. (shrink)