State legislation has not clearly established legal or ethical standards for the minimum amount of information an individual needs prior to making the decision to become a donor or to remain a non-donor. Nonetheless, some states have taken action to increase the amount of background information that individuals must receive before they decide to become registered donors. Some state actions provide that looped videos, pamphlets, and posters be present at divisions of motor vehicles, designed to enhance the awareness of the lay public as a "captive audience" in the waiting rooms of licensing offices. In some states, division of motor vehicles personnel provide explanations regarding donation. However, these measures, which are not always properly or consistently implemented, may not provide adequate information to meet informally recognized legal or ethical standards of informed consent. Further efforts should be made to decrease the disparity of information given to grieving families in the consent process and that given to individuals considering becoming donors. This could increase expansion of state donor registries and enhance the strength of the advance directive.
A second broad issue also involves utilizing the driver’s license as a means to entering individuals into a donor registry. Driver’s license renewal cycles vary from every two years to the absence of a renewal requirement, although a common cycle is every four years. An optimal cycle to encourage consent to organ donation has not been determined, and it has not been demonstrated whether cycle length affects a new driver’s decision. However, a decreased renewal frequency has the effect of both decreasing the number of times that drivers will be asked to think about becoming donors, and opportunities for donation and donor registry information to provided to the public via division of motor vehicles offices, or through fact sheets included with renewal notice packets.
An additional concern is that most states offer an individual an opportunity to donate when they first get their driver’s license, typically at 16 years of age. Generally, the age at which individuals may legally donate is 18 years of age. Individuals are consequently forced to make decisions about donation before the issue is relevant to them and may not have the opportunity to change their decision until the renewal of their license, given a typical renewal period of 4 years. The discordance among obtaining a driver’s license, becoming a legal organ donor, and the driver’s license renewal period may pose a barrier to consent.
A number of states have taken actions that may provide some assurances that the registry process is based on informed consent. Extensive donation training programs for division of motor vehicles personnel improves the quality of information they provide to the public, increases their comfort level in discussing the topic of organ and tissue donation, and may even have the effect of making them active proponents of donation. Ultimately, training increases public education and results in a more informed registered donor pool. Finally, as a way of validating a donor’s wishes as accurate and informed, two states send thank-you letters to registered donors soon after they are entered into the registry to confirm their commitment to become a donor.