Increasing Organ Donation and Transplantation: The Challenge of Evaluation. A. Legislation


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.
  1. 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.
  1. 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).