Category Archives: organ donation

Global Giving: Open Grant Proposal

Here’s an unusual thing for you to read: I am posting a brief description of a grant proposal that I will submit for the ‘vici’-competition of the Netherlands Organization for Scientific Research 2019 later this year. You can download the “pre-proposal” here. It is called “Global Giving”. With the study I aim to describe and explain philanthropy in a large number of countries across the world. I invite you to review the “pre-proposal” and suggest improvements; please use the comments box below, or write to me directly.

You may have heard the story that university researchers these days spend a lot of their time writing grant proposals for funding competitions. Also you may have heard the story that chances of success in such competitions are getting smaller and smaller. These stories are all true. But the story you seldom hear is how such competitions actually work: they are a source of stress, frustration, burnouts and depression, and a complete waste of the precious time of the smartest people in the world. Recently, Gross and Bergstrom found that “the effort researchers waste in writing proposals may be comparable to the total scientific value of the research that the funding supports”.

Remember the last time you saw the announcement of prize winners in a research grant competition? I have not heard a single voice in the choir of the many near-winners speak up: “Hey, I did not get a grant!” It is almost as if everybody wins all the time. It is not common in academia to be open about failures to win. How many vitaes you have seen recently contain a list of failures? This is a grave distortion of reality. Less than one in ten applications is succesful. This means that for each winning proposal there are at least nine proposals that did not get funding. I want you to know how much time is wasted by this procedure. So here I will be sharing my experiences with the upcoming ‘vici’-competition.

single-shot-santa

First let me tell you about the funny name of the competition. The name ‘vici’ derives from roman emperor Caesar’s famous phrase in Latin: ‘veni, vidi, vici’, which he allegedly used to describe a swift victory. The translation is: “I came, I saw, I conquered”. The Netherlands Organization for Scientific Research (‘Nederlandse organisatie voor Wetenschappelijk Onderzoek’, NWO) thought it fitting to use these names as titles of their personal grant schemes. The so-called ‘talent schemes’ are very much about the personal qualities of the applicant. The scheme heralds heroes. The fascination with talent goes against the very nature of science, where the value of an idea, method or result is not measured by the personality of the author, but by its validity and reliability. That is why peer review is often double blind and evaluators do not know who wrote the research report or proposal.

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Yet in the talent scheme, the personality of the applicant is very important. The fascination with talent creates Matthew effects, first described in 1968 by Robert K. Merton. The name ‘Matthew effect’ derives from the biblical phrase “For to him who has will more be given” (Mark 4:25). Simply stated: success breeds success. Recently, this effect has been documented in the talent scheme by Thijs Bol, Matthijs de Vaan and Arnout van de Rijt. When two applicants are equally good but one – by mere chance – receives a grant and the other does not, the ‘winner’ is ascribed with talent and the ‘loser’ is not. The ‘winner’ then gets a tremendously higher chance of receiving future grants.

As a member of committees for the ‘veni’ competition I have seen how this works in practice. Applicants received scores for the quality of their proposal from expert reviewers before we interviewed them. When we had minimal differences between the expert reviewer scores of candidates – differing only in the second decimal – personal characteristics of the researchers such as their self-confidence and manner of speaking during the interview often made the difference between ‘winners’ and ‘losers’. Ultimately, such minute differences add up to dramatically higher chances to be a full professor 10 years later, as the analysis in Figure 4 of the Bol, De Vaan & Van de Rijt paper shows.

matthew

My career is in this graph. In 2005, I won a ‘veni’-grant, the early career grant that the Figure above is about. The grant gave me a lot of freedom for research and I enjoyed it tremendously. I am pretty certain that the freedom that the grant gave me paved the way for the full professorship that I was recently awarded, thirteen years later. But back then, the size of the grant did not feel right. I felt sorry for those who did not make it. I knew I was privileged, and the research money I obtained was more than I needed. It would be much better to reduce the size of grants, so that a larger number of researchers can be funded. Yet the scheme is there, and it is a rare opportunity for researchers in the Netherlands to get funding for their own ideas.

This is my third and final application for a vici-grant. The rules for submission of proposals in this competition limit the number of attempts to three. Why am I going public with this final attempt?

The Open Science Revolution

You will have heard about open science. Most likely you will associate it with the struggle to publish research articles without paywalls, the exploitation of government funded scientists by commercial publishers, and perhaps even with Plan S. You may also associate open science with the struggle to get researchers to publish the data and the code they used to get to their results. Perhaps you have heard about open peer review of research publications. But most likely you will not have heard about open grant review. This is because it rarely happens. I am not the first to publish my proposal; the Open Grants repository currently contains 160 grant proposals. These proposals were shared after the competitions had run. The RIO Journal published 52 grant proposals. This is only a fraction of all grant proposals being created, submitted and reviewed. The many advantages of open science are not limited to funded research, they also apply to research ideas and proposals. By publishing my grant proposal before the competition, the expert reviews, the recommendations of the committee, my responses and experiences with the review process, I am opening up the procedure of grant review as much as possible.

Stages in the NWO Talent Scheme Grant Review Procedure

Each round of this competition takes almost a year, and proceeds in eight stages:

  1. Pre-application – March 26, 2019 <– this is where we are now
  2. Non-binding advice from committee: submit full proposal, or not – Summer 2019
  3. Full proposal – end of August 2019
  4. Expert reviews – October 2019
  5. Rebuttal to criticism in expert reviews – end of October 2019
  6. Selection for interview – November 2019
  7. Interview – January or February 2020
  8. Grant, or not – March 2020

If you’re curious to learn how this application procedure works in practice,
check back in a few weeks. Your comments and suggestions on the ideas above and the pre-proposal are most welcome!

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Will a presumed consent system increase the number of organ transplantations?

Update, February 28, 2018: The Netherlands Senate (Eerste Kamer) has voted in favor of the opt-out system proposed in parliament. The vote was close: 38 senators were in favor, 36 voted against. The ministry of Health, Wellbeing and Sports announced that the law will be implemented in the summer of 2020. The law creates another natural experiment with changes in defaults, which will be interesting to monitor. The evidence reported from other countries in the post below suggests that the change will increase the number of organs available for transplantation.

Update, September 16, 2016: The Netherlands parliament (Tweede Kamer) has recently voted in favor of a law changing the opt-in system to an opt-out system. In December 2015 Wales shifted to an opt-out system. The first results are promising. A study that was published in 2014 also suggests that the change will increase the number of transplanted kidneys. Whether and when the change will take effect in the Netherlands depends on a vote in the House of Lords (Eerste Kamer).

In the Netherlands, post mortem organ donation still requires active registration of consent. The number of post mortem organ transplantations is low. Is there a connection between these two circumstances? Would changing the system to presumed consent in case of non-registration increase the number of organ transplantations?

These questions are at the heart of a new debate about organ donation, spurred by a proposal of the liberal democratic party (D66) to change the system, presuming consent and introducing an ‘opt out’ rule. It is believed that such a change will save lives by increasing the number of organ donors.

Is this true? Will changing to an opt-out system save lives? What do we know about the effect of presumed consent? You will not be surprised that researchers from various scientific disciplines have examined the effects of organ donation policies. But before I give some of the details of these studies, we need to carefully formulate the research question. In this case the question is: what should be the dependent variable in the debate?

In my view, what counts is the number of ‘lives saved’. The number of patients that successfully received an organ of a post mortem organ donor is the relevant outcome variable, and not so much the number of organ donors available. Obviously a presumed consent system increases the number of organ donors available for transplantation. Here’s a graph showing the ‘effective consent rate’ – i.e., the proportion of the population not declining consent – from a 2003 article by Johnson & Goldstein in Science

The problem is that presuming consent does not automatically increase the number of successful transplantations. You can see that the difference in the number of transplantations between countries with an opt in (voluntary registration) or opt out (presumed consent) system is much less dramatic.

optin_optout

Now about the independent variable. Many studies – including the Johnson & Goldstein article from which the graphs above are taken – have looked at differences between countries. These differences, however, cannot tell us whether a change in the system will save lives.  The only feasible policy recommendation we can make from an analysis of differences between countries is about migration: to which country should people move in order to have the best chance of receiving an organ from a post mortem organ donor? If we want to know the effect of a change in the system on the number of lives saved, we should look at changes over time in the number of successful transplantations in countries that have changed the system to an opt out / presumed consent system.

The benefits of an opt-in system seem less positive when we look at the changes in the numbers of lives saved in several countries that have recently changed to an opt-in system, as described in a 2008 article by Coppen and colleagues in BMC Health Services Research. Italy changed the system in 1999 and shows an increase in the organ donation rate. The increase cannot be attributed fully to the change to an opt-in system, however. The increase already started in 1995. Sweden changed to an opt-in system in 1996, but shows no increase in the organ donation rate in the years thereafter. The study covered 10 countries in the period 1995-2005.

A more recent study by Bilgel in the European Journal of Health Economics, covering a larger set of 28 countries and a longer time period (1993-2006), did find positive effects of system changes.  The study also shows that it is important whether family or next of kin is asked for consent and can veto donation, regardless of donor consent. The study shows that changing into an opt-out system works best if family/next of kin are routinely asked  for consent.

Previous debates on organ donation policy in Dutch parliament did not result in a system change. If the system remains unchanged, there is still room for improvement, as shown by a recent study from the UK by Wellesley in the British Medical Journal. Citizens may be ‘nudged’ into donation simply by more actively soliciting registration choices, for instance when applying for a new driver’s licence. Similar experiments have been conducted in the Netherlands, and they seem to have been successful.

The Netherlands have also been successful in increasing the number of living organ donors, as shown by a graph from a recent article in the Economist (below). These are mainly kidney transplantations by kin.

The problem, however, is that these nudges do not move the masses. The nudge is in the right direction, Wellesley acknowledged, immediately asking the follow up question: “but is it enough?” If only new applicants for driver’s licences are nudged into donation, it will take ages before the current waiting lists for organs are cleared. “It is time to move to presumed consent for organ donation”, Bird and Harris, also from the UK, concluded in a response to the Wellesley study. In the British Medical Journal, Rieu, an Oxford Ethicist, provides another good summary of the debate and comes to a similar conclusion.

The change to a presumed consent system may change the norm, also for family and kin who have the power to veto the deceased’s consent with donation. Citizens in countries with an opt-out system are more willing to consent with donation of another person’s organ, as shown in a 2008 study using survey data by Mossialos, Costa-Font and Rudisill.

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