Making Death Enhance Life

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Few things can be more maximally inverse than:

Making Death Enhance Life.

The Nudge Videos (see Comfort Videos) are in use at several Organ Procurement Organizations (OPO) – that also obtain consent for Tissues (like Cornea) in addition to Organs  – to increase Next-of-Kin (NOK) consent rate from relatives of the deceased (who had not given First Person Consent, FPC). This is known as Second Person Consent.

Each Tissue consent can help up to 75 patients, while each Organ consent can help up to 8 folks waiting for transplant.

Here is an approach from the first year of the Nudge Video initiative that illustrates how our video is typically used by an OPO with the NOK.

  • Sunday, September 18th, 2016.
  • Potential Deceased Donor: Female, 46, Black, Baptist.
    • 10:15 a.m. – Received a call from triage saying that the family wanted to withdraw shortly. Large family presence.
    • 11:25 – Arrived. Huddled with the room nurse and head of ICU. Both said there have been around 50 people there since the patient was admitted 2 days prior (siblings, partner, church, neighbors/co-workers/friends). Both said the family had been “all over the place”, the patient’s siblings wanting to withdraw but not wanting to pressure the very emotional son and father. They had just made the patient DNR but wasn’t sure if they were also withdrawing.
    • 11:50 – ICU attending said that she spoke to the family, they want to withdraw at around noon, comfort care ordered.
    • 12:00 – Asked attending to introduce me. She pulled the son and his dad into the conference room and was present during the approach. Dispelled myths about donation including mutilation fears. Discussed timing and “she’s already been through enough.” Their primary concern ultimately was timing – they’d already wrapped their heads around withdrawal, the entire family/community was gathered to say their goodbyes. They said they’d have to talk to other family members
    • 12:27 – Offered and texted Nudge video to both son and his dad, said it was a short video about other families like theirs who’d considered donation. Encouraged them to take a few minutes to watch it and that could share it with other family members.
    • 12:27:35Nudge Link was activated
    • 12:45 – Son and father returned and wanted to move forward with organ donation
    • 13:26Obtained written consent.

Here are some results from one other OPO – see Paradise Reimagined for who they are, how they were trained and so on – in a typical week:

Overall Total:  Videos shown 10 times with 7 authorizations for an overall authorization rate of 70%

Showed the Tissue Video 9 times with 6 authorizations after family watched for a 66.7% authorization rate

  • 8 families watched the tissue clip, 6 said yes and 2 declined
  • 1 family was sent the clip, but no contact was ever made

Showed the Organ Video 1 time and got 1 authorization for 100%

This initiative is complementary – and maximally inverse –  to the usual focus on increasing FPC. As I mentioned in my prepared remarks to the NASEM Committee on Organ Transplantation:

The first order problem in transplantation is lack of supply. First Person Consent (FPC) rates have plateaued, and morbidly, one has to wait for such a person to die in a medically acceptable manner relatively quickly. This can hardly be considered an acceptable solution to the pressing problem of today. There is a much larger opportunity to increase supply right now through second person consent, from legal next-of-kin (NOK). Our field experiment using videos that are already freely available (in English and Spanish) with Nevada Donor Network indicates that this intervention is a zero-cost option that results in nudging next-of-kin towards increased consent. Widespread use of such videos across Organ Procurement Organizations (OPOs) can be immediately helpful nationwide.

A particular satisfying aspect of this Nudge Video initiative is that it is not a one-off but something that has been incorporated in their ongoing workflow and seamlessly infused into their organizational processes and culture. This is what made SmartOps so successful in optimizing global supply chains: we were part of their weekly planner workflow integrated with their ERP and APS systems. While I have done many one-off implementations – Network Design, Product Portfolio Rationalization and so on – SmartOps Enterprise Inventory Optimization (EIO) is the software (now part of SAP IBP) that is in on-going use at 700+ global companies in 50+ countries supporting Trillion + dollars of commerce.

OM research that enhances ongoing practice within organizations is where impact is truly created.

Since the beginning of the Nudge initiative – the first time our video was used at an OPO I believe was in February 2016 – I have lost count of the thousands of people annually

=(number of OPOs using Nudge Videos * number of approaches/week * fraction successful * number of patients affected by one additional NOK consent*52)

who may have benefited from the additional supply of tissues and organs across the various states in the US.

At no risk to my life, of course, and at minimal cost and pretty modest effort, this “Nudge List” can be considered maximally inverse to:

Schindler’s List is a 1993 American historical drama film directed and produced by Steven Spielberg and written by Steven Zaillian. It is based on the 1982 non-fiction novel Schindler’s Ark by Australian novelist Thomas Keneally. The film follows Oskar Schindler, a German industrialist who saved more than a thousand mostly Polish-Jewish refugees from the Holocaust by employing them in his factories during World War II. It was nominated for twelve Academy Awards, and won seven, including Best Picture, Best Director, Best Adapted Screenplay, and Best Original Score. It was also a box office success, earning $322 million worldwide on a $22 million budget.

I remember bumping into Mark K. (our previous Provost) at Casbah once, who introduced me to a guest that he  was hosting at dinner there, and highlighted my work on Organ Transplantation: Nudge Videos and OrganJet (which is maximally inverse in its own way, taking patients to organs rather than bringing organs to patients). When I responded – like I usually do, including at guest lectures at HBS and HKS, that “I don’t know how many people my playfulness has helped, how many lives it has saved, and, in any case, these  initiatives really are largely effortless and minimally inconvenient to my everyday life,  and I doubt if I should get much praise for it, you know, unlike Oskar Schindler”, his response was:

Saving a life is saving a life. In Jewish belief, whoever saves one life saves the entire world.

I am not Jewish. Although, I have been mistaken for being one. After a Tepper alum event in Boston where I was the speaker, some years back, a few MBA alums and I went to Stephanie’s on Newbury, and we were discussing SmartOps and Venture Capital and such. A drunk (White Male, although I do have a few Karen stories too!) sitting at the bar comes over to me and yells: Are you a f**cking Jew?  I responded instantly with a smile: No, but thanks for the compliment. ☺️He did not know what to do; he just froze! Then the restaurant manager walked him back to his seat and apologized to us all, offering to pay for our drinks.


I am just a playful, free-spirited individual who embraces Oscar Wilde at his maximally inverse best:

Life is too important to be taken seriously.

My own attempt to mimic Oscar, not Oskar 😏 (as I opened in An Essay on Operations Management):

I am serious about being playful.

Seriously, though, let me close with another approach and the use of Nudge Video.

  • While having another conversation with the NOK, I mentioned that I was available to speak to his brother-in law in Utah and to answer any questions about the donation process for him. I then mentioned that I have a short video I could email or text his brother-in-law that has even more information if he would like.
  • The NOK stated that he thought that would be good and asked if he could have the video sent to him as well.
  • The video link was sent to brother’s and brother-in-law’s numbers.
  • Immediately after the text was sent, the brother walked over and asked how to view it. I guided him to click on the link from his phone and click on the arrow to play the video.
  • He walked away looking down at the phone as it was playing.
  • When he made the decision to donate, he stated that:
  • If he could help one person, why wouldn’t he do this?”

Like I previously mentioned in A la recherche de moins de temps about OrganJet, although I have been doing Nudge Videos for years, it also never gets old. Embracing my new (superposition) state as an Academic Philanthropist, here is a paper that recently appeared online showing the efficacy of this approach:

Video intervention to increase decedent tissue donation by next-of-kin.





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