IV.

The role of the government in organ donation is significant. Aside from enforcing guidelines for defining brain death and thus potential donor status, governments plays have a role in the procurement process by legislating that certain steps, particularly referral and request, take place regularly, and that OPOs meet a minimum donation rate benchmark for certification. Government initiatives can also help increase donation by including donor information with tax forms or drivers license applications.

Sample hypothesis: State Required Referral laws will ensure that hospital staff contact the OPO when a potential donor has been identified.

Sample evaluation options:

1. Compare referral and donation rates (DPMP) of states with Required Referral laws to states without Required Referral laws.

• Strengths: contemporaneous, non-random control group; large study size; links a post-event measure to the donation rate.
• Weaknesses: retrospective; potential underlying differences among compared states may bias results; DPMP may provide biased results if the underlying population in the compared states are different.

2. Measure hospital referral rates after enactment of a required referral law.

• Strengths: post-event measure.
• Weaknesses: no control group – there is no way to know if any change in referral rates can be attributed to enactment of the law, or to other contemporaneous factors.

3. Survey public opinion on organ donation in a given state before and after the implementation of the Required Referral law.

• Strengths: has a comparison group; prospective.
• Weakness: public opinion (pre-event measure) about organ donation is not well-linked to actual increases in the donation rate; lack of an external comparison group makes it difficult to determine whether changes in public opinion can be attributed to the law or to some other factor (e.g., increased media coverage in the state).

Another set of programs focuses on provider education and organization. These programs address hospital and OPO readiness to effectively handle potential donors so as to maximize organ donation. Such programs might include training for hospital and OPO staff, involvement of OPO staff in the hospital infrastructure, and other similar efforts.

Sample hypothesis: Placing OPO coordinators on-site at hospitals will facilitate the organ donation process and increase organ donation rates.

Sample evaluation option:

1. Select 50 trauma centers without in-house OPO coordinators and randomly assign 25 to receive an in-house OPO coordinator. Measure the difference in donations per potential donor after 6 months.

• Strengths: prospective; randomized; externally controlled; donation rate measure.
• Weaknesses: expensive to conduct medical records review and to continue study for a 6 month period; sample size is potentially too small to detect statistically significant differences.

Perhaps the programs with the highest profile nationally are those that are geared towards raising public awareness towards organ donation issues. There are 269 million people in the US, only a very small fraction of whom will become potential donors (fewer than 20,000 annually). Consequently, for every potential donor, a public awareness campaign must reach, on average, approximately 13,000 people. Casting such a wide net for a small number of donors complicates evaluation of actual effect on donation. However, there are intermediate measures that can be especially useful in gauging programs’ important side effects, such as public education and awareness. Though these do not correlate directly with donation, they can be considered worthy goals on their own in that they can affect national and regional acceptance and support of organ donation programs.

Sample hypothesis: A statewide media campaign consisting of radio and print ads will increase the organ donation rate in the state.

Sample evaluation options:

1. Survey 100 families who chose to donate organs and 100 families who chose not to donate organs to determine if the media campaign had any effect on their decision.

• Strengths: controlled; focused on families closest to actual donation.
• Weaknesses: retrospective; response rate to survey may vary by donors and non-donors, biasing results; donating families may have self-selected for reasons other than media campaign.

2. Field a survey that classifies respondents according to the five stages of change, based on Prochaska’s transtheoretical change model (1992), before and at two month intervals after the media campaign is implemented.

• Strengths: prospective; stronger measure of campaign success than general public opinion survey.
• Weaknesses: self-controlled; not proximal to actual donation event (pre-event measure).