Increasing Organ Donation and Transplantation: The Challenge of Evaluation. A. Pre-Event Measures


Pre-event measures are most commonly used to evaluate activities that precede the trauma leading to brain death. Though frequently used as a proxy for program effectiveness on donation rates, they are process measures that serve as weak predictors of actual donation rates. A media campaign to increase the number of people who become organ donors when they renew their driver's licenses could be deemed successful if significantly more people signed donor cards than in months past. However, the link between the number of new licenses with organ donation approval and the donation rate is uncertain at best. A large follow-up study would be required to determine whether the process of signing a donor card had an impact on a family’s decision to donate organs. The link between pre-event measures and the primary goal of increasing organ donation is weak.

Many researchers are striving to improve pre-event measures by using these measures to assess the five stages of behavioral change that may lead to organ donation, i.e.: precontemplation, contemplation, preparation, action, and maintenance. These five stages of change were developed by Prochaska et al. (1983), originally in relation to smoking cessation programs. Studies in the areas of smoking cessation, mammography use, and weight loss programs have attempted to: 1) design measures for the stages of change, 2) determine if the stage of change correlates to success in the designated program, and 3) determine if activities can be implemented to improve cycling through the stages of change. These activities are evaluated relative to activities that were not specifically designed to promote cycling through stages of change. In the field of organ donation, these stages of change can be thought of as follows (Rohr, manuscript).

  • Precontemplation: the person has not thought about donating organs.
  • Contemplation: the person has thought about donating organs.
  • Preparation: the person has made phone calls or requested information about organ donation.
  • Action: the person has taken action to express his/her wishes about organ donation (e.g., signed a donor card, talked to a lawyer, discussed wishes with family).
  • Maintenance: the person may occasionally remind or reinforce statement of wishes.

Multiple studies have indicated that familial consent for organ donation is one of the biggest barriers to donation. Other papers have shown that families are more likely to consent to donation if the deceased individuals have made their wishes known. Applying the stages of change methodology to measure progress towards action may be a useful indicator of outcomes. For example, stages of changes measures can be developed to determine whether a particular intervention moved people to sign donor cards and discuss organ donation with their families.