Encouraging Organ Donation: Evidence from a Randomized Informational Intervention Among Young Adults in Tunisia

The study will take place at the South Mediterranean University, which comprises two main departments: engineering and business.
In partnership with the CNPTO, we will organize an Organ Donation Awareness Week on campus. In this occasion, we will display posters in the university's atrium and students will be free to engage with the material on their own. This light-touch intervention will be in the background of a more targeted expert-led informational intervention.

There is one treatment arm which consists in the expert-led informational intervention. CNPTO representatives will visit the treatment classes of the engineering school and those of the business school during regular teaching activities on Monday and Tuesday. Using a short powerpoint presentation, the representatives of the CNPTO will explain the medical procedure behind organ donation and its benefits for the patients and society at large. Moreover, they will provide details on the administrative procedure around organ donation in Tunisia and explain students how they can add their donor status to their ID. The intervention will also include a short video testimonial from a patient who survived thanks to a heart transplant administered by the CNPTO.

After the Q&A the intervention team will leave the classroom and the students will fill in the first endline survey in the form of a Qualtrics questionnaire on their mobile device or personal computer. In the control group, the questionnaire will be distributed by the lecturer on the same days as in the treated classes.
A short text included at the end of the survey will inform students that the technical police will be on campus offering on-the-spot ID changes on Thursday and Friday during the day. The timing of the study implies that students who consider adding their donor status to their ID have some time to think about their decision. There will be no monetary or in-kind incentives for changing one's ID. We are collaborating with a police agent who has worked with the CNPTO to provide on the spot ID changes in the occasion of the Tunis Marathon. The University will provide a separate room for her and the photographer who will take biometric photos. We will ensure to create a safe environment, adequately train the police and the photographer beforehand, and monitor them closely during the data collection.

2025-04-07

2025-04-08

We treat ID changes as our primary outcome because it is a behavioral outcome reported by an external observer who is blind to the students' treatment status. Students will have the possibility to add their donor status to their ID on the spot. In accordance with the Tunisian Law n° 99-27 of March 1, 1999, this requires signing an official donor declaration form.

The CNPTO has offered on-the-spot ID changes in previous awareness events following the same procedure. Based on their experience, we expect it to take 10-15 minutes. In compliance with our Ethics protocol and the General Data Protection Regulation of the European Union, we will ask the students who have added their donor status to their ID if they are willing to share this decision with the research team. They will be given a printed privacy form and consent form by the representative of the technical police. We will collect the signed consent forms and digitize the names of the signatories after the intervention. We will then match this data with the baseline and endline surveys to measure how many students from treatment and control group respectively change their ID to declare their donor status. The outcome will be coded as 1 for students who change their ID and 0 otherwise.

We measure and analyze four secondary outcomes: 2. Attitudes towards organ donation and social norms, 3. Administrative and legal knowledge, 4. Medical knowledge, 5. Trust in medical institutions.

The secondary outcomes are measured with a Qualtrics survey tool in the first and second endline. These outcomes, especially the attitudes, social norms and trust measures, may be subject to experimenter demand effects and social desirability bias, which is why we consider them as secondary outcomes. However, they will allow us to shed light on potential mechanisms to better understand how the treatment works.

At endline, we ask students to guess the number of peers who will sign up to become organ donors during the Organ Donation Awareness Week. This outcome is incentivized; the student who gets closest to the true number will receive a voucher worth 50 Tunisian dinars for the cafeteria.

These outcomes are mostly measured on a 4-point Likert scale. For knowledge items, we use a "yes"/"no" or "correct"/"wrong" scale. The question items measuring trust in medical institutions are modeled after the most recent waves of the Arab Barometer (2023) and the World Values Survey (2022) and scored on a 4-point Likert scale.

We have identified 40 classes without student overlap. After gathering consent from the university and lecturers we will randomly allocate 20 classes to a treatment and 20 classes to a control condition. The randomization will be stratified by department (engineering vs business) and level of study (year of study).

We used an algorithm to choose disjoint classes with no student overlap. We identified 40 disjoint classes with N=900 students. This is the maximum number of students we can reach, assuming all students complete the surveys and all lecturers agree to participate in the research project.
Among these classes, we will randomly choose 20 for treatment using the computer.

The treatment is randomized at the classroom level.

Yes

40 classes

900 students

20 classes treatment, 20 classes control

Based on our pilot data, we expect that 3.8 percent of all students are already organ donors (standard deviation 0.191). We assume a significance level alpha of 0.05 and a power of the test beta of 0.8. With respect to our main outcome, ID changes, we are therefore powered to detect a 3.6 percentage points increase in the share of individuals who declare their donor status in their ID.