| Study |
Overview |
Evaluation |
Performance
Indicators |
Stage
of Activity |
Target |
Findings |
Comments |
| Public
Awareness |
| Cosse 1997 |
Media campaign in US by the
Advertising Council, Inc. to educate US public about organ and tissue donation (Phase II
July 1995, Phase II October 1995). |
Time series |
Pre-event measures: % who
expressed a positive attitude towards organ donation; % who signed donor card |
Pre-event activity |
Community |
Campaign found an increased
percentage of people taking action to sign a donor card after the campaign. |
The activity described is one
step removed from actual organ donation, but was successful in terms of raising awareness.
However, the media campaign wasn’t isolated, other activities may have also
contributed to this change (e.g., reports about famous recipients like Mickey Mantle and
David Crosby). |
| Schutt 1997 |
A mailing campaign and public
lectures were coordinated through a large medical insurance company; other materials were
distributed via affiliated hospitals and the local news media. |
Time series |
Rate of organ donation
increased by 30% during first 3 months of 1997 compared with same time previous year. |
Pre-event activity |
Combined public/ hospital/
primary care provider awareness |
The rate of organ donation
increased in 1997, although PCPs were reluctant to distribute information to patients. |
Multi-faceted approach with a
baseline measurement and follow-up based on actual rate of organ donation. No way to tell
which facet of the program had largest impact. No attempt to control for other confounding
factors that may have influenced the donation rate. |
| Persijn 1997 |
Various public education
efforts and the professionalization of an information dissemination office. |
Time series |
Pre-event |
Pre-event |
Community |
Increase in different
promotional materials disbursed. |
Very easily collected, but
more an illustration of a dissemination office increasing its activity intensity- no
post-event or outcome measurements. |
| Townsend 1990 |
Discussion groups to educate
the African-American community about donation. |
Time series |
Pre-event |
Pre-event |
Community |
Increase in donation approval
and family discussion after group meeting. |
Questionnaire easy to collect,
but difficult to link activity to organ donation. |
| Kappel 1993 |
Two phase effort to increase
donation from the African-American community: public education and minority requestor. |
Time series |
Post-event |
Pre-event |
Community |
Increase in black referrals,
but consent rate remained the same. |
The disconnect between
referral and consent was discussed; data simple to collect; small sample size (5/16 and
4/31). |
| Callender 1991 |
Various efforts for
African-American community education. |
Time series |
Pre-event
Donation rate |
Pre-event |
Community |
Increase in donor cards signed
at DMV over campaign. Increase
in donations over period of campaign. |
Good measure of approval/
commitment, easy to collect.
Used only # of donations in 80-89; no rates
to adjust for population size or technological advances over a decade; not clear what
aspect of a multi-faceted program had the most positive effect. |
| Wolf 1997 |
National strategy to promote
public acceptance of organ donation. |
Cross-sectional survey
(incomplete) |
Pre-event |
Pre-event |
Community |
Media penetration strong;
positive response in favor of donation for those viewing campaign. |
Survey fairly easy to collect
but must be large; no comparison of change in attitudes of those who hadn’t seen
campaign for control. |
| Gallup 1993 |
Survey on public attitudes
about donation. |
N/A – survey |
Pre-event |
N/A |
Community |
National approval of organ
donation, etc. |
Baseline only- might be useful
to measure difference over time or by region of intervention. |
| Stratta 1997 |
Hypothesis that organ donation
rate would increase if the public could be assured that donated organs are appropriately
used. |
N/A |
Consent rate, rate of nonrecovery (including donor instability and
inability to find recipient), disease/damaged organs, consent rate, utilization |
Post-donation |
Community |
N/A |
Not a true evaluation but
analyzes steps in the process to identify areas for future activity. Recognition that
consent is part of the issue, but hospital needs to improve efforts to use a retrieved
organ. |
| Provider
education and hospital/OPO organization |
| BNA, Feb. 2, 1998 |
Retrospective survey of donor
families and critical care staff concerning perceptions of quality of care and training
respectively. |
Case-control study |
Post-event measures, but focus
on quality of hospital care. |
Post-event |
Hospital, donor and nondonor
families |
Donor families ranked the
quality of care their loved one received higher than non-donor families. |
Although this study does not
evaluate an activity, the information from this study can be used to identify new
interventions to improve quality of care and increase donations. |
| Chabalewski 1997 |
A program to promote a greater
emphasis on organ donation issues in nursing education programs in the US. |
Time series |
Pre-event measures of how many
schools incorporate donation & transplantation activities in their curriculum |
Pre-event |
Hospital – Nursing
schools |
Nursing schools have become
more aware and have started to incorporate more Donation &Transplantation courses and
information in their curriculum. |
Study is an indirect proxy of
ultimate organ donation Focus on those directly involved in the organ procurement process
post-event, but indirect. Study possibly could be followed up to link education to
attitudes and success in clinical practice. |
| Garrison 1991 |
Analysis of Kentucky OPO
performance over one year. |
Cohort |
Post-event |
Post-event |
Donors/ families |
Consent rate higher in cohort
for whom requests were decoupled from brain death explanation. |
Nondeliberate, but good
design: presumably randomization of decoupled request though small number of hospitals
suggests issues about one or two poor requestors who might have skewed results. |
| Hartwig 1993 |
Effect of organ donor race on
health team procurement efforts. |
Cohort |
Post-event |
Post-event |
Hospital |
African-American patients are
less likely to be identified, asked, or become donors. |
Sample size decent- 85 and 67;
use of MRR mitigated potential for skewed results from staff knowing there is interest in
studying this issue; MRR involves time and effort. |
| Niles 1996 |
Evaluation of the timing
factor in the consent process. |
Cohort |
Post-event |
Post-event |
Donor/ families |
Decoupled requests more
successful. |
Retrospective study;
relatively easy to collect data; OPO-wide sample large enough to be significant. |
| Cutler 1992 |
An analysis of donation events
in one OPO over two years. |
Cohort |
Post-event |
Post-event |
Donor/ families |
OPO coordinators more
effective at soliciting consent than physicians. |
Study doesn’t give
numbers of cases, only rates, and says physicians ask most often- if much more often,
coordinator success might be less on account of coordinator status than particular success
of one good coordinator. |
| Sheehy 1996 |
Comparison of procurement
success between trauma and non-trauma hospitals. |
Cohort |
Donation rate, post-event |
(No activity) |
Hospital |
Trauma centers are more
effective at each of the post-event steps and in donation rate. |
Baseline data only; MRR used
is relatively expensive. |
| Beyer 1992 |
Study of donations at a
Midwest tertiary care hospital over six months. |
Cohort |
Post-event |
Post-event |
Donor/ families |
Physician request consent rate
higher than when nurse requests; consent rate also higher with higher Death Anxiety Scale
(DAS) scores and more liberal religious beliefs (1-6 scale). |
Regressions performed to
calculate results; sample size of 228 requests might be too small to break out so many
variables with significance; prospective design stronger than most. |
| Beasley 1997 |
Impact of a
comprehensive, hospital-focused intervention to increase organ donation over two years at
50 hospitals in three OPOs. |
Time series |
Post-event, donation rate |
Post-event |
Hospital (from OPO) |
All measures from ID to
donations increased pre-intervention to post-intervention. |
Large sample lends
credibility, as does pre- and post-intervention, rather than during, when there might be a
learning curve; data collection largely a part of intervention except MRR, which is
relatively onerous. |
| Cohort |
Post-event |
Post-event |
Hospital (from
OPO) |
Consent rate
higher among cohorts for which request was decoupled, made in a quiet/private setting, and
OPO coordinator involved. |
Again, large
sample lends credibility, though results might be skewed in that procurement staff might
not have followed guidelines for decoupling, etc., even in the midst of an intervention. |
| Shafer 1997 |
Impact of inhouse coordinators
on organ donation rates in non-donor hospitals, a single coordinator has a contractual
obligation to identify and manage potential donors. |
Time series |
Donation rate Post-event measures: Organ donor referrals, donor
count, consent rate |
Post-event |
Hospital level, but sponsored
by the OPO |
The program has been a
cost-effective way of assisting OPO’s efforts to recover organs from hospitals in
Texas. |
Actual evaluation with
outcomes measures, 3-year follow-up. Working directly in the hospital post-event to
improve family consent rates, routine notification, and communications with the OPO. |
| Gentry 1997 |
Using an "appropriate
messenger" (Dr. Callender) approach by hiring an African-American to spearhead a
minority community education program and having an on-call African-American coordinator to
increase donation rates. |
Time series |
Organ donation Post-Event: Consent Rates
Referral rate
Medically suitable donor referrals |
Post-event |
OPO program initiated at the
hospital level |
Consent rates and donation
rates increased among African-American donors. |
Targeted population in North
Texas, focus on increasing minority consent Study design does not control for other
potential confounding factors that could have impacted the donation rate beyond the
OPO-coordinator program. |
| Shirley 1994 |
Assessment of one OPO’s
efforts to increase donation by a variety of initiatives. |
Time series |
Donation rate, post-event |
Pre-event, Post-event |
Hospital (from OPO) |
Doubling of referrals and
donations since beginning of program. |
Large enough results that
program probably works, but the role of each part of a multi-faceted campaign unclear;
data easy to collect. |
| Politoski 1994 |
Description of continuing
education program offered by the National Kidney Foundation. |
Time series |
Post-event |
Pre-event |
Hospital |
After the workshop, nurses are
more likely to identify donors, initiate requests, and accompany requestor. |
Relatively easy to collect;
translation of pre-event intervention to post-event behavior particularly good (though
link to success of these requests would be instructive)- contemporaneous controls might
have been useful. |
| Burris 1996 |
Effect of a program to define
a donation policy, educate staff, and document and monitor compliance at one institution. |
Time series |
Donation rate, Post-event |
Post-event |
Hospital, Donors/ families |
After implementation of CQI,
significant increases in referrals and donations. |
Good to measure both donation
rate and post-event indicators: sample size for donation rate larger (so more confidence
in results), but post-event measures are also significant. Use of request protocol form
facilitated data collection. |
| Kappel 1993 |
Two phase effort in increase
donation from black community: public education and minority requestor. |
Time series |
Post-event |
Post-event |
Donors/ families |
Increase in consent rate over
time. |
Good to use post-event
measure, but sample size might be too small- researcher doesn’t explain why referrals
actually went down over the year of intervention. |
| GAO 1993 |
Survey of OPOs on their data
collection variables. |
N/A --Survey |
Post-event |
Pre-event |
OPO |
What variables OPOs collect,
and to what extent. |
Point: OPOs should collect
more, and more consistent, data. |
| Savaria 1990 |
Feedback solicited from
families of donors. |
N/A --Survey |
Pre-event, Post-event |
Post-event |
Donor/ families, Community |
Questions asked about whether
donor had donor card or family discussion before precipitating event; also reasons for
donating. |
No comparison with control
group of non-donor families; 50% response rate compromises results; sensitive issue;
relatively inexpensive. |
| Shafer 1997 |
Study of organization of three
successful organ procurement organizations. |
N/A --Survey |
Outcomes, Post-event,
Pre-event, other |
Both |
OPO |
No conclusions drawn, just
benchmarks suggested for successful OPOs. |
Might have relevance with much
larger sample sizes that include true cross-section of OPOs (not just three successful
ones) to see which variables really do correlate with success. |
| Morris 1990 |
Performance of one hospital
over 3 years. |
Single case |
Post-event |
Post-event |
Hospital |
Baseline data established. |
Sample size of 10 over 3 years
compromises results; MRR to determine potential donors might have been costly. |
| Kowalski 1996 |
Assessment of a
hospital’s establishment of an Office of Decedent Affairs, whose staff facilitate
various aspects of the donation process. |
Single case |
Outcome |
Post-event |
Hospital |
After office consolidation,
donation rate tripled. |
Outcome measure suggests
success, but unclear which aspect of a multifaceted effort is responsible; easily
measured. |
| McNamara 1997 |
Medical record review to
determine organ procurement effectiveness. |
Methods |
Donation rate, Post-event |
Post-event |
OPO, Hospital |
MRR is stronger than death
certificate review which is stronger than DPMP as performance measures. |
Good methodological
recommendations. |
| Evans 1992 |
Death certificate review to
determine organ procurement effectiveness. |
Methods |
Donation rate |
Post-event |
OPO, Hospital |
Gives two death certificate
review methods to determine potential donor pool. |
Methodological recommendation;
baseline data only. |
| Wight 1997 |
Describes the European Donor
Hospital Education Programme skills workshop and Donor Action, a program designed to help
hospitals improve policies and procedures to optimize donation process with 5 modules:
donor detection, referral, family care and communication, maintenance, retrieval. |
N/A |
Pre-event measures: Increasing
attitude, knowledge, communication, teamwork; Post-event: increasing approaches to families
Donation rates via MRR |
Pre-event activity to help
hospitals better handle events |
Hospital |
N/A |
Donor Action program has
targeted key weaknesses and identified areas where the most donors were being
"lost" -- changes could be measured on a hospital by hospital basis -- this
article does not describe any evaluation. MRR and hospital staff surveys are generally
expensive to conduct. |
| Matesanz 1997 |
Proposal of future activities:
proactive donor detection programs with specifically trained professionals, education of
the legal profession, social education of health professionals, media, and public opinion,
and organizational structure of the organ donation system are all crucial. |
N/A |
Ultimately would have to
include all three performance indicators |
Pre-event |
Range of activities targeting
all stakeholders |
N/A |
Proposes a wide range of
activities but no planned evaluation beyond national organ donation rates and country vs.
country comparisons. |
| Legislation
|
| Roels 1996 |
Evaluates presumed consent
policies in Austria and Belgium. |
Cohort |
Donation rates |
Pre-event |
Community |
DPMP higher in countries with
presumed consent policies. |
Without mention of baseline,
not clear that differences don’t correlate with societal differences, but use of two
countries eases this issue somewhat- perhaps baseline data could have been included as a
historical control; easy to measure. |
| Bergstrom 1997 |
Swedish Transplant
Coordinators’ experience with the New Transplantation Act and Donor Register which
switched presumed non-consent to presumed consent – Government led information
campaign, national database of donors and an attitude survey. |
Time series |
# of donors, survey of
pre-event measures (e.g., donor card signing), and post-event measures (consent rates) |
Pre-event |
Community |
No difference in number of
donors in Sweden had been detected. |
This study provides one
example of how difficult it is to measure changes in the donation rate due to legislation
and public awareness activities. The time span of the study may have been too short to
detect differences. |
| Bacque 1997 |
Development of laws (in
Argentina) to ensure transparency and sanitary safety in the development of organ
transplantation – Organ Transplant Law 1977 created the National Organ Procurement
Organism, shift towards improving provider attitudes and creating a new operational model
– Hospital Coordinator Model, and educational campaigns. |
Retrospective time series |
DPMP, post-event, and
pre-event measures. Percentage
of multiorganic retrieval,
Family refusal rates,
Percent lack of information about brain
death and corpse integrity,
Religious refusal,
Percent mistrust |
Pre-event |
Community, hospital providers |
Found an increase in donation
rates and numbers of organs retrieved since legal organization of the organ donation
system; Outlines goals for new model as Argentina moves forward. |
Measures organ donation
outcome on a county by county level, measures intermediary predisposition to organ
donation. Accounts for effect of government and transplantation model. Age of donors has
remained relatively constant. |
| Nitschke 1997 |
Comparing legislative periods
in Germany with transplantation law and without law but with a centralized system of organ
procurement; describes role of the Eurotransplant Foundation to standardize allocation
procedures. |
Time series |
# of potential organ donors
and outcome: effective donors and organs retrieved; refusal rate influenced by the media |
Pre-event |
Community |
The new allocation procedures
seem to be successful, despite moving to a system that requires next-of-kin consent. |
This study measures real
outcomes and controls for the death rate but does not control for the fact that the
increase in organs may be due to differences in the donor identification rate or other
population differences. |
| Transplant News 1996 |
Illinois donor card registry. |
Surveillance |
Pre-event |
Pre-event |
Community |
% of drivers registered as
donors by region used to determine where awareness is lacking. |
Good use of registry data to
focus later program initiatives; could eventually link this data to actual donation rates. |
| Roels 1997 |
Presumed consent policy in
Belgium. |
Surveillance |
Pre-event |
Pre-event |
Community |
Rate of opt-outs determined
for natives and foreigners. |
Baseline only; could use this
data to determine change over time, and compare with other countries. |
| Overcast 1984 |
Survey of OPOs and state
District Attorney offices. |
N/A --Survey |
Pre-event (donation rate
connection hinted at anecdotally) |
Pre-event, Post-event |
Community |
Most states allow donor
designations on licenses; anecdotal information given on % of actual donors who had been
donor card carriers; most states don’t have official protocol for police to search
for a donor card on an accident scene. |
Potential to use registries to
link actual donors with donor card carriers mentioned, but only anecdotally mentioned. |
| Rosental 1997 |
Comparison of informed versus
presumed consent law in Baltic States - creation of unified Baltic transplant network. |
N/A |
Donations per million
population, development of joint policy, adopting legislation, unified waiting list |
Pre-event |
Community |
Rates of transplantation were
similar in the Baltic states; the states are now unified by the Balttransplant
organization. |
Not a true evaluation, could
be evaluated if comparisons are made at baseline (pre-organization) and at intervals after
baseline. |