More than 90 percent of the public supports organ donation, yet less than half the population registers as donors, surveys show.
What if registration was better promoted to those who had previously turned it down? And at the place almost everyone makes that decision, the DMV?
Research at 40 Department of Motor Vehicles facilities in Illinois shows such efforts can make a difference. An article about the work was published in the September/October issue of the journal Clinical Transplantation.
University of Illinois professor Brian Quick and his research colleagues implemented a phased multiple-message campaign that placed printed materials - in the form of brochures, counter mats and posters - in 20 of those 40 facilities during four months in 2011. They also trained volunteers to hand out materials and provide information to visitors, and then scheduled those volunteers in the facilities during the middle two of those four months.
They also conducted a media campaign with radio and billboard ads (roadside and bus) during the first two months of the campaign, in the areas those 20 facilities served.
Half of the 20 had historically had a high rate of donor registration, and half low. The other 20 facilities in the study served as a control group, also split between historically high- and low-registration facilities.
The result for the 20 sites that got the campaign was a "statistically significant" reduction in the downward trend for registration at driver facilities, when compared to those in the control group, according to Quick, whose research focuses on health communication. He is a professor in the department of communication and in the College of Medicine at Illinois.
The improvement was not dramatic, but Quick said the findings were meaningful because most of those who registered this time had likely been asked before and declined, as part of their previous license renewal. The question has been part of the license renewal process since Illinois created its first-person, legally binding consent registry for organ donation in 2006.
"We were not going after the lowest-hanging fruit" in the campaign, Quick said. "We were seeking people who were resistant to registering as organ donors."
When media, materials and volunteers were all in place, in the second month of the study, the historically low-registration facilities that got the campaign showed a registration rate of 17.75 percent, compared to 15.22 percent for those in the control group. Among the historically high-registration facilities, the rates were 23.83 percent vs. 20.95 percent.
A similar though declining difference in rates then persisted into the last two months of the study, even as mass media ads were removed from the campaign and volunteers were then withdrawn from facilities.
In the first years of the registry, people signed up at a much higher rate in Illinois, Quick said. Because people stay on the list thereafter, however, and those remaining have likely declined to register at least once (not counting new drivers), the annual rate of registration has naturally declined, he said.
Similar studies have been conducted in other states, but this was the first to examine the effectiveness of a multiple-message campaign aimed at growing a "mature registry" several years old, where many people were being asked a second time to register, Quick said.
Other efforts in driver facilities might also be effective, and might be studied in future research, such as training DMV staff to answer questions about donor registration, he said.
Researchers don't know what keeps more than half the population from registering as organ donors, Quick said. Fear and distrust may be part of what is holding people back, he said.
"And sometimes I think people just don't want to do it, and they just don't have the heart to tell you they don't want to do it," he said.
"Our research suggests, however, that individuals are much more likely to say yes when they understand that as many as eight lives can be saved, and 25 others improved, by a single donor," he said.
- Brian Quick, Tyler R. Harrison, Andy J. King, Dave Bosch. It's up to you: a multi-message, phased driver facility campaign to increase organ donation registration rates in Illinois. Clinical Transplantation, 2013; DOI: 10.1111/ctr.12208
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