Increasing Organ Donation and Transplantation: The Challenge of Evaluation. I. Introduction


  This paper offers a guide for evaluating activities designed to increase organ donation. While the organ donation community has been very active in attempts to increase organ donation, there has not been a concerted effort to determine the best methodologies for evaluating these activities. Although many activities have been evaluated at some level (e.g., counting donor card signatures), there is relatively little understanding about how these activities relate to the goal of increasing the number of organs available for transplantation. (Appendix B provides an overview of evaluations of organ donation activities.) Well-planned and methodologically sound evaluations, coupled with program goals and timeframes, provide the cornerstone for understanding program effectiveness. Rigorous evaluations of activities designed to increase organ donation will better inform resource allocation among alternative and complementary programs.

The organ donation community is not alone in its intent to develop methodologically sound strategies for evaluating its activities. Recently, similar evaluation efforts have focused on evaluating such behavior modification programs as: smoking and substance abuse prevention and recovery programs, programs to increase use of mammography and other forms of cancer screening, physical activity promotion efforts, occupational health activities, and other health education programs. For example, a review of AIDS education program evaluations in 1990 found that many of the evaluations failed to use standard evaluation designs (e.g., time series) and had no information linking changes in knowledge to behavior changes (Forst 1990). Other behavioral modification evaluations have been more successful in applying rigorous evaluation designs. (Appendix C provides an overview of evaluations in these areas).

This paper outlines the three essential components of a successful evaluation, namely: 1) rigorous evaluation methodology, 2) tested performance indicators, and 3) an activity to evaluate that is related to the ultimate goal of the program. Exhibit 1 provides an overview of these elements and how they inform and influence each other. The paper begins with an overview of evaluation methods and a discussion of the relative merits of such methods. It then turns to a discussion of the performance indicators appropriate for organ donation activities. Finally, the paper presents examples of evaluation elements for selected types of organ donation activities.

Exhibit 1: Overview of Evaluation Planning
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Source: Lewin, 1998