2010: NHS Blood and Transplant, Customer Insight - Case Study

A campaign based on remarkable insights into the contradictions people feel about registering as organ donors dramatically changed attitudes to this difficult issue.

Key insights

• Getting people to reveal their true feelings about registering to be organ donors showed that focus groups only deliver reliable insights if the right questions are asked.
• Turning the tables by asking people if they would want an organ transplant if they needed one highlighted the confusion most people felt about such a sensitive issue.
• Playing on this ‘right’ sort of guilt kick-started a very successful campaign.

Summary

The National Health Service Blood and Transplant (NHSBT) was established to oversee the provision of a reliable, efficient supply of blood, organs and associated services to the NHS. Because the UK has one of the lowest rates of organ donation in Europe, there are 8,000 people registered for a transplant who face the dilemma of having to wait for an organ. 1,000 people die every year while waiting for a donor organ to become available.

To improve these shocking statistics the government set the NHS a target to increase the number of people registered with the Organ Donor Register (ODR) from 16 million to 25 million by 2013 — an extra nine million registrations in three years. To achieve this, the NHSBT commissioned a campaign to increase awareness and support of organ donation as an issue and convert this support into registrations.

Building the campaign on the insight that people give because they want to receive produced remarkable results. In the first five weeks the campaign generated 128,218 completed registrations, exceeding the estimated target by over 400%.

Setting the scene

The task was formidable. The UK had one of the lowest rates of organ donation in Europe. As a result there were 8,000 people waiting for a transplant, with 1,000 sadly dying before one became available. The NHSBT needed to boost the number of registrations on the ODR from 16 million to 25 million by 2013 — an extra nine million registrations in only three years. The specific goal was to generate 37,600 registrations in the first five weeks alone. This meant the campaign would have to be eight times more effective than the average health advertising campaign.

Quantitative research revealed that 90% of people in the UK said that they were ‘in favour of organ donation’ although only 27% had registered with the ODR. Interestingly, it was found that the main barriers to registration were largely rational: “l don’t know how to”, “l hadn’t thought about it”, “l didn’t know about the ODR”. So it looked at first sight that the campaign could be quite straightforward: remind the 63% of adults ‘in favour’ but not on the register to register. As one man pointed out in groups, “You don’t wake up every morning thinking I must register to be an organ donor today”.

Discovering a not-so-simple truth

So groups were held where respondents were set a simple task: to write down how they felt when they were told: “I just want you to register to donate your organs, today”. This, it was felt, would create a sense of urgency and push them to do it. This, however, wasn’t the reaction. Instead of agreeing it was a good idea, people were horrified and felt under pressure.

It turned out that thinking about organ donation was anything but straightforward. Instead, that question unlocked deeper and unsettling emotions about the idea of death and tempting fate. People needed to be given a more compelling reason why they should donate their organs.

More groups, representative of the British public, were then recruited to explore other possible approaches. At first, it looked as though guilt about the fact that three people were dying every day because of a lack of organs would be a powerful motivation. While this shocked people and struck a chord with them about the importance of organ donation, it also unlocked a ‘bad guilt’ which left people feeling angry that they seemed to be unfairly blamed for people dying.

After all, organ donation isn’t like giving blood where the donation can help save lives straight away. With organ donation you need to die before your organs can be used, so it’s unlikely your registration will help people on the register today. So while guilt was indeed a powerful emotion, it had to be the right sort of guilt: guilt about not being on the register.

So a different approach was tried: what about making people feel good about saving lives and leaving a legacy? After all, there is no better gift you can leave than the gift of life. While this resonated with people, it only put organ donation on the ‘list of things to do before I die’. It lacked any sense of urgency.

Delving deeper found some submerged but strong superstitions. Seemingly rational people would say things like, “Well, I want to be buried whole, not walking around in heaven with my organs missing”. These superstitions were confronted head-on by pointing out that they would be dead, and therefore didn’t really need their organs. Although, when challenged, people agreed they were being irrational, these beliefs were so deep-set that they were simply not something that could be changed overnight.

Cracking the code

The fact that it had already been established that 90% of people were ‘in favour’ of organ donation and yet were so reluctant to register was a puzzle. A psychologist was brought in to try and explain what was happening. His story about vampire bats transformed the campaign approach.

Group help

Vampire bats need to feed on blood every two days or they will die. They get blood from other bats who regurgitate it for them. Because access to blood is vital, it seems vampire bats have decided it is in their interest to feed any bat in the colony, not just family members, even though that bat may not feed them in return. However, by feeding any bat, they are actually widening the pool of potential feeder bats, improving their chance of getting fed in return. This is known as reciprocal altruism.

Using the bats as a metaphor, the thinking changed to whether it would make more sense not to ask people if they would be willing to donate an organ, but would they be willing to receive one. Asking people in groups that simple question produced a response that was both surprising and uncomfortable to watch. Not only did people say that yes, of course they would take one but, as they answered the question they started to squirm, quite literally, and giggle nervously as the hypocrisy of their answer dawned on them.

As soon as they realised what was in it for them, their consciences got the better of them. After all, if they were prepared to receive an organ, shouldn’t they be prepared to donate one? This had resonated with their inherent sense of fairness. Organ donation is not like charity where giving makes you feel good. It’s about reciprocity. You give because you hope that when the time comes, you will receive. And research backed that up: 96% of people agreed that ‘if they needed an organ they would take one’. This was not only the ‘right’ guilt, but it pointed the way to getting people to register.

Striking a dramatic tone

The campaign dramatised the contradictory nature of the issue: that if one of their loved ones needed a transplant, they would gladly take an organ yet would make excuses to put off registering. The campaign line ‘If you believe in organ donation, prove it’, posed a challenge to the viewers because the moment they answered ‘yes’ it would be very hard to argue against registering. This strategy also offered a new public relations (PR) angle to exploit: exposing the statistics behind the hypocrisy — that 96% of us are willing to take an organ yet only 27% are registered. This created a ripple effect across media channels, generating discussions about whether people would accept an organ or not and whether this reflected the attitudes of our society.

Figures 1 and 2 are examples of the press campaign, while Figure 3 shows some stills from the TV execution.

A key part of securing registrations was to give people time to connect with the subject, to talk about it with family or friends, but then ‘act’ by registering as quickly as possible, before they talked themselves out of it. That led to a two-pronged media strategy: first to get consumers to ‘connect’ with the issue among friends and family; then to ‘act’. The ‘connect’ phase involved 30-second TV ads in key media spots that attracted a captive family audience (e.g. Emmerdale, Murderland, ITV news) and large full-page press ads in the tabloids and broadsheets.

The ‘act’ phase converted intention into registrations as fast as possible, utilising online banners, pre-roll video ads, small-space press and 10-second reminder TV ads to prompt action. In addition, the website was streamlined and simplified to ensure registration could be completed in just two pages.

Surpassing targets

In the first five weeks the campaign achieved a total 187,820 responses, which converted into 128,218 completed registrations, beating the estimated target by over 400%. The advertising was well-recognised and achieved a prompted campaign awareness of 60% among adults, with 57% seeing two to five media channels. Importantly, strong support for organ donation as an issue increased from 36% to 54% among those who had seen the campaign.

The PR from the campaign generated an additional 110,851,094 opportunities-to-see (OTS) and the total coverage of the issue generated a total of 326,940,322 OTS.

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