Why the use of health self-tracking apps can facilitate organ donation

Research Highlight Why the use of health self-tracking apps can facilitate organ donation

One important inhibition to organ donation is the perception that it equates to giving away part of the self. To remove this barrier, and address the acute worldwide shortage of organ donors, Chi Hoang and her co-author showed that the use of physiological self-tracking devices can shift the way we think about our bodies, and encourage more positive attitudes towards organ donation.

In the same way as most people support the idea of renewable energy but very few actually want to see wind turbines outside their house – the well-known NIMBY (not in my backyard) syndrome –, theoretical support for organ donation is widespread yet the percentage of actual organ donors is low. In the US alone, more than 112,000 people are waiting for organ transplants, and recent World Health Organization data indicates that some 129,000 transplants are performed annually worldwide, which is less than 10% of the global need.

What stands in the way of organ donation? Unfortunately for the hundreds of thousands of patients in urgent need of a new kidney, liver or heart, many factors make people uncomfortable with the idea of giving away a part of their body, even after they have passed away (85% of organs come from deceased donors, not living ones). Barriers include religious restrictions and political views, health concerns, and a desire to keep the body intact.

The crucial role of body and self-perception

But one of the most important drivers of organ donation decisions may be the way one perceives the body with respect to the self, according to a duo of researchers. In a novel paper published in the Journal of Consumer Psychology, Professors Chi Hoang and Sharon Ng point out that one major obstacle to organ donation is the perception that donating an organ is equivalent to giving up part of the self. They write: “Conversely, people who believe that the self and body are distinct express a greater willingness to donate and receive organs (Sanner, 2001).” Drawing from findings of prior research, the authors postulate that encouraging people to view their body as distinct from their self may mitigate concerns about a loss of self when donating organs. How can such a “dualistic” view be encouraged, then?

The theory of self-body dualism was originally formulated by Descartes almost 400 years ago, but the authors point out that “many contemporary philosophers [...] argue that the physical body and non-physical mind are just aspects of the same thing – that is, the self.” The debate is unlikely to ever be resolved once and for all, and different individuals hold different beliefs about the body-self distinction depending on their age, religion, gender, etc. Yet contextual factors also play a part. Professors Hoang and Ng add that “research in cognitive neuroscience shows that when people focus on physiology (e.g., thinking of the body in terms of its parts, such as cells and organ functions), the body appears distinct from the self (Blanke & Metzinger, 2009; Metzinger, 2004, 2005).” Crucially for the issue of organ shortage, the authors propose that focusing people's attention on physiological aspects of the body will facilitate a dualistic view, and in turn, encourage greater organ donation.

The facilitating role of self-tracking devices

To this end, the researchers suggest using physiological self-trackers, or instruments that convey precise information about bodily functions. A wide variety of apps and devices (such as Fitbit smartwatches and other high-tech gadgets, or the Apple Health app) are available on the market and increasingly popular. Most provide stats about heart rate, number of breaths, and other health metrics in numerical format or as graphs.

“Current physiological self-tracking apps and devices enable people to view their bodies according to quantifiable measures, such as the number of heart beats per minute, respiration rate, or the speed of blood running through the veins,” write the researchers, who then posit that “physiological self-tracking should shift people's bodily perception toward dualism” as it breaks down the body (so to speak) into separate indicators. In turn, this dualistic perception may facilitate organ donation by reducing feelings of self-loss that might arise from thoughts of parting with one's heart or liver.

One important caveat: these predictions apply to self-trackers that provide data on specific body functions, but not broader life measures (mood, stress, or fat-burning rate). Indeed, those concerning whole-body activity entail the processing of global, not local, bodily information, which is more likely to activate the self-concept – thus defeating the purpose.

To test their hypotheses, the researchers conducted three studies with hundreds of participants from Singapore, the US and the UK. The participants were put through various physical and cognitive activities to observe the effect of physiological self-tracking on organ donation intentions and to disentangle the dualistic body perception from other potential motives.

The results do support the proposition that self-tracking facilitates more positive attitudes, as well as stronger actual behavioural intentions to donate organs. Indeed, after the first study, more participants in the self-tracking condition (29.3%) opted to receive an organ donation pledge form than in the control condition (15.4%). The second study, which tested potential drivers behind the observed effect, found that the main explanation was participants' dualistic bodily perception rather than rational or emotional thinking, or elevated self-worth. Finally, the third study manipulated participants' dualistic belief to encourage organ donation behaviour. Regarding this specific lever for action, the authors do however warn that too much reference to self-body dualism could backfire, and reverse organ donation tendencies.
Still, the overall finding – that physiological self-tracking increases acceptance of organ donation – is robust, as long as it concerns self-trackers that provide information regarding specific, not whole-body, metrics. Therefore, policymakers could leverage this new, smart technology to devise new methods for addressing the current shortage of organ donors.