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

Last registered on March 07, 2025
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Pre-Trial

Trial Information

General Information

Title
Encouraging Organ Donation: Evidence from a Randomized Informational Intervention Among Young Adults in Tunisia
RCT ID
AEARCTR-0015516
Initial registration date
March 07, 2025

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
March 07, 2025, 8:56 AM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name
Christina Sarah Hauser
Affiliation
European University Institute
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Other Primary Investigator(s)

PI Name
Maleke Fourati
PI Affiliation
Mediterranean School of Business
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Additional Trial Information

Status
In development
Start date
2025-03-10
End date
2025-10-31
Keywords
Behavior, Health
Additional Keywords
organ donation, health, institutional trust
JEL code(s)
I12, I15, O17, F63
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Organ transplantation saves lives and improves the life quality of patients, reducing reliance on costly invasive treatments. The technology is becoming available in LMICs, but the gap between organ demand and supply remains substantial. Our previous work suggests that inadequate information and low trust in institutions contribute to Tunisia's organ shortage. In a randomized controlled trial at a Tunisian university, we assess the impact of an expert-led informational intervention on young adults’ attitudes towards organ donation and their donor status. To the best of our knowledge, this study is the first to assess the causal effect of an informational treatment on willingness to donate organs in a non-Western context, focusing on both attitudinal and behavioral outcomes. Our study also relates to the literature on the importance of institutional trust for public health. Finally, by accounting for students’ social networks, we contribute to the literature on information spread through social networks.
External Link(s)

Registration Citation

Citation
Fourati, Maleke and Christina Sarah Hauser. 2025. "Encouraging Organ Donation: Evidence from a Randomized Informational Intervention Among Young Adults in Tunisia." AEA RCT Registry. March 07. https://doi.org/10.1257/rct.15516-1.0
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Experimental Details

Interventions

Intervention(s)
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.
Intervention Start Date
2025-04-07
Intervention End Date
2025-04-08

Primary Outcomes

Primary Outcomes (end points)
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.
Primary Outcomes (explanation)
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.

Secondary Outcomes

Secondary Outcomes (end points)
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.
Secondary Outcomes (explanation)
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.

Experimental Design

Experimental Design
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).
Experimental Design Details
Not available
Randomization Method
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.
Randomization Unit
The treatment is randomized at the classroom level.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
40 classes
Sample size: planned number of observations
900 students
Sample size (or number of clusters) by treatment arms
20 classes treatment, 20 classes control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
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.
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Ethics Committee of the European University Institute
IRB Approval Date
2024-12-20
IRB Approval Number
20240227-HAUSER
IRB Name
Ethics Commitee of the South Mediterranean University
IRB Approval Date
2025-03-04
IRB Approval Number
N/A
Analysis Plan

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