Further legislation is needed in those states with lesser-developed donor registries to diminish the disparity that currently exists in the degree of registry development. The majority of state registries operate at only a very basic level, while a small number have more developed databases. Many states do not have a registry at all.
Registry maintenance and technical support involves determining where the database is to be housed, ensuring compatibility between the various entities that will utilize the registry, and developing mechanisms for keeping the database up-to-date. Several recent pieces of state legislation in this area have focused on addressing various parts of this process, although innovative efforts such as including visual representations of donor documentation also have been made in a small number of states.
Finally, the cost of maintaining and supporting a donor registry could be substantial, and funding mechanisms need to be established for this process to advance. Costs include those for purchasing and upgrading hardware and software, and personnel to operate and maintain the database.