Reasons for (not) Signing the State Registry: Surveying Department of Motor Vehicles Customers in New York State

Increasing Organ Donor Registrations in Motor Vehicles Offices Through Health Communication

Health communication research has played a prominent role in the body of scholarship seeking to meaningfully increase the number of life-saving organs available to waitlisted patients. The current paper builds on earlier work in communication seeking to promote organ donation to individuals in community and organizational settings. The goal of this essay is to review health communication-based interventions seeking to meaningfully increase organ donation registrations in motor vehicles' offices (DMV) transactions in the USA. For convenience, I use the acronym DMV, although it is understood different states use different titles for this office. Before describing the nature and impact of communication interventions and their impact in DMV contexts, I will provide context for the problem and briefly review the role of DMV registrations in relation to demand for organs in the United States.

Can Happiness and Sadness Overcome Organ Donation Barriers Following Exposure to Radio Ads?

Concerns related to bodily integrity, medical mistrust, superstition, and disgust with respect to organ transplantation remain commonly cited barriers among African American, Caucasian, and Hispanic non-donors. The current study examined two narrative strategies for mitigating these barriers by eliciting feelings of happiness or sadness. African American, Caucasian, and Hispanic non-donors (N = 576) were randomly assigned to a radio ad that communicated either a recipient narrative or a waiting list narrative. As expected, the recipient narrative elicited greater feelings of happiness whereas the waiting list narrative aroused greater feelings of sadness. Moderated mediation analyses revealed models in which happiness, not sadness, was the mediator, such that the narrative frame was associated with ad persuasiveness. Additionally, only medical mistrust interacted with happiness to predict ad persuasiveness The results are discussed with an emphasis on message design strategies to employ among reluctant adult African American, Caucasian, and Hispanic potential donors.

Life beyond life: Perceptions of post-mortem organ donation and consent to donate-A focus group study in Italy

OBJECTIVES

Many factors such as personal and cultural beliefs, misinformation, fear of death and inadequate will registering procedures can influence post-mortem organ donation. The present study aimed to explore the perceptions, beliefs and information around post-mortem donation and will expression in different groups of the Italian population, to orient future interventions and raise awareness.

DESIGN

Qualitative research with focus groups.

METHODS

A total of 38 focus groups involving 353 participants including the general population (young adults: 18-39, mature adults: 40-70), local and hospital health professionals, critical area health professionals (emergency room and intensive care), registry office employees and opinion leaders, were conducted in six regions from different parts of Italy between June and November 2021. Thematic analysis was conducted with the use of Atlas.ti9.

RESULTS

Five overarching themes were identified: dilemmas regarding donation, resistance to donation, facilitators of donation, difficulties in terms of will expression and proposals to encourage will expression. Possible facilitators were having personal and professional experiences with organ donation, feeling useful for society, having reliable information and trust in the health care system. Potential barriers to donation were doubts and fears about brain death, bodily integrity concerns, religious beliefs, misinformation and distrust in the health care system.

CONCLUSIONS

These results highlighted the significance of a bottom-up perspective with regard to identifying the personal perceptions and beliefs with regard to donation, underlining the urgency of creating tailored interventions to sensitize different groups of the population in terms of promoting an informed choice and a culture of donation.

Sex Disparities in Organ Donation: Finding an Equitable Donor Pool

Background

The majority of living organ donors are women, but few are deceased organ donors, which increases risks associated with sex mismatched organs. We sought to identify reasons for sex disparities in organ donation and strategies for equity.

Methods and Results

Using Amazon's Mechanical Turk, we examined US adults' perceptions regarding donation in a mixed‐methods survey study. Results were compared by sex with Fisher's exact test and T‐tests for quantitative results and qualitative descriptive analyses for write‐in responses. Among 667 participants (55% women), the majority of men (64.8%) and women (63.4%) self‐identified as registered donors. Women's willingness to donate their own organs to family members (P=0.03) or strangers (P=0.03) was significantly higher than men. Donors from both sexes were guided by: desire to help, personal experience, and believing organs would be useless to deceased donors. Non‐donors from both sexes were guided by: no reason, medical mistrust, contemplating donation. When considering whether to donate organs of a deceased family member, women were equally guided by a family member's wishes and believing the family member had no further use for organs. Men had similar themes but valued the family member's wishes more. Among non‐donors, both sexes would consider donation if more information was provided.

Conclusions

In a national survey, both sexes had similar reasons for becoming and not becoming an organ donor. However, compared with men, women were more willing to donate their organs to family members and strangers. Improving education and communicating wishes regarding organ donation with direct relatives may increase sex equity in deceased organ donation.

An examination of teenagers' beliefs toward organ donor registration

Teenagers represent a promising target population for organ donor registration efforts, as in the US teenagers age 15-17 may register their intent for organ donation, which later translates to consent at age 18. However, teenagers constitute a relatively understudied population in the organ donation literature. A sample of teenagers (N = 466) ranging in age from 13 to 19 was recruited from driver's education schools in Ohio and Michigan in order to learn more about their perceived reasons for and against registering as an organ donor. A coding scheme was developed, and responses were coded by two trained coders. In line with previous work in adult samples, our results revealed the three most common reasons for registering were prosocial benefits, rational arguments, and personal experience. In contrast to previous work among adults, the two most common reasons for not registering were bodily integrity and religious reasons. Several novel beliefs among teenagers that were both supportive and non-supportive of organ donor registration were identified. Findings from the current study are discussed with an emphasis on implications for practitioners working to promote organ donor registration among teenage audiences.

The Impact of Mortality Salience on Organ Donation Attitude, Beliefs, and Behavior

The current study examines the relationship between mortality salience and attitude, beliefs, and behavior toward organ donor registration. Participants (N = 484) completed a laboratory study in a 2 (mortality salience vs. control) x 2 (processing: distal vs. proximal) between-subjects factorial design. Dependent variables included death thought accessibility, attitude, information seeking, and organ donation beliefs (bodily integrity, ick, jinx, and medical mistrust). Differences between conditions were examined with independent samples t-tests and χ2 analyses. Participants in the mortality salience condition reported greater death thought accessibility than those in the control; however, no difference in attitude nor information seeking (non-donors only) was found between the two conditions. No difference in attitude nor information seeking (non-donors only) was observed between participants engaging in distal versus proximal defensive processing. Participants in the mortality salience condition reported higher medical mistrust and bodily integrity than those in the control condition; no difference between ick or jinx was found between the two conditions. Theoretical and practical implications are discussed.

An Examination of Nursing Students' Knowledge About Organ Donation

BACKGROUND

Nurses play an important role in educating the public about organ donation, but only if they themselves are knowledgeable on the topic. This study examined nursing students' knowledge of common myths and misconceptions related to organ donation.

METHOD

Nursing students (N = 232) completed an anonymous online survey. Eight true/false questions assessed nursing students' knowledge of organ donation.

RESULTS

Overall, nursing students were knowledgeable about organ donation, correctly answering on average 5.55 of 8 questions. Nursing students were least likely to believe the myths that medical providers are untrustworthy and that organ donors are unable to have an open casket funeral, but they were most likely to believe the myth that there is a black market for organ donation in the United States.

CONCLUSION

The results provide useful data to nurse educators seeking to prepare the next generation of nurses to be knowledgeable and competent communicators on the topic of organ donation. [J Nurs Educ. 2020;59(7):388-391.].

'If I donate my organs it's a gift, if you take them it's theft': a qualitative study of planned donor decisions under opt-out legislation

Background

There is a worldwide shortage of donor organs for transplantation. To overcome this, several countries have introduced an opt-out donor consent system. This system, soon planned for Scotland and England means individuals are automatically deemed to consent for organ donation unless they register an opt-out decision. This study was designed to explore the reasons underpinning donor choices for people who plan to actively opt-in to the register, take no action and be on the register via deemed consent, opt-out, and those who are unsure of their decision.

Methods

This study reports the analysis of free-text responses obtained from a large survey of intentions towards opt-out legislation in Scotland, England and Northern Ireland (n = 1202). Of the n = 1202 participants who completed the questionnaire, n = 923 provided a free text response explaining their views. Thematic analysis was used to explore the reasons why participants plan to: opt-in (n = 646), follow deemed consent (n = 205), opt-out (n = 32) and those who were not sure (n = 40).

Results

A key theme for people planning to opt-in is that it ensures one’s donor choice is explicitly clear and unequivocal. Some regarded deemed consent as unclear and open to ambiguity, thus actively opting-in was viewed as a way of protecting against family uncertainty and interference. For the deemed consent group, a key theme is that it represents a simple effortless choice. This is important from both a pragmatic time-saving point of view and because it protects ambivalent participants from making a challenging emotive choice about organ donation. Key themes for those planning to opt-out relate to fears around medical mistrust and bodily integrity. Notably, both participants who plan to opt-out and opt-in perceived presumed consent as “authoritarian” and a method of increasing Government control of organs. In response, registering an active decision protected their freedom of choice.

Conclusions

The findings highlight the importance of registering deliberate active consent for people who choose opt-in, due to concerns over possible family refusal under deemed consent. These findings could inform the development of communication campaigns that encourage family communication before the implementation of opt-out legislation.

Illinois Department of Motor Vehicle Customers’ Reasons for (Not) Registering as an Organ Donor

Context:

Organ donation campaigns are maximized when promotional messages address salient issues among the intended audience. A diverse sample (N = 1573) was recruited to identify the reasons for (not) registering as an organ donor.

Objective:

Relying on an established coding scheme, an updated explanation for why individuals register (or not) as organ donors is provided. Moreover, registration trends with respect to race, biological sex, and age is presented.

Method:

Participants exiting Department of Motor Vehicle offices (N = 12) were surveyed to understand their reasons for registering and not registering as organ donors.

Results:

Benefits of donation followed by prior registration, rational arguments, and personal experiences represented nearly 90% of the coded responses for registering. Conversely, negative beliefs, decisional uncertainty, perceived disqualification, no reason, general fear/disgust, and lack of opportunity constituted nearly 90% of the coded responses for not registering as an organ donor. Whites and Latinx individuals were more likely to register as organ donors compared to African Americans. Participants in the lower (18-24) and upper (65+) age brackets had the lowest donor registration rates.

Conclusion:

Promotional efforts should continue to target younger and older audience segments with information about organ donation as well as African Americans. Results from the current study suggest emphasizing the benefits of organ donation as well as overcoming negative beliefs, decisional uncertainty, and perceived disqualifications.

An evaluation of a motor vehicle facility campaign with an established statewide donor registry: A test of sustainable, evidence-based intervention strategies

Increasing organ donor registration enrollment inside motor vehicle facilities (MVF) is a common approach in the United States. From this research, a formula for what works has emerged within the literature including the presence of an interpersonal component, video messages, and point-of-decision materials. These intervention components have demonstrated effectiveness at increasing registrations in relatively new statewide registries; however, their effectiveness in MVFs with a mature registry remains understudied. The current study examined the effectiveness of an online MVF clerk intervention and the other examined the effectiveness of a multi-message, phase MVF intervention aimed at increasing organ donation registrations. The results revealed that MVF clerks garnered increased knowledge and greater comfort in communicating about organ donation with patrons after the intervention. Moreover, the intervention revealed that clerk talk effectiveness was positively associated with organ donation registration among MVF customers. Against expectations, recall of video messages was negatively associated with new registrations. Exposure to the brochure, counter mat, and poster donation messages was not associated with organ donation registration. An emphasis on the strengths and shortcomings of using MVFs as intervention sites for organ donation registration promotion are discussed.

A quantitative appraisal of African Americans' decisions to become registered organ donors at the driver's license office

African American (AA) organ donation registration rates fall short of national objectives. The goal of the present study was to utilize data acquired from a quantitative telephone survey to provide information for a future Department of Motorized Vehicles (DMV) intervention to increase AA organ donor registration at the DMV. AAs (n = 20 177) that had visited an Alabama DMV office within a 3-month period were recruited via direct mailing to participate in a quantitative phone survey. Data from 155 respondents that participated in the survey were analyzed. Of those respondents deciding to become a registered organ donor (ROD; n = 122), one-third made that decision at the time of visiting the DMV. Of those who chose not to become a ROD (n = 33), one-third made the decision during the DMV visit. Almost 85% of all participants wanted to learn more about organ donation while waiting at the DMV, preferably via TV messaging (digital signage), with the messaging delivered from organ donors, transplant recipients, and healthcare experts. Altruism, accurate organ donation information, and encouragement from family and friends were the most important educational topics to support AAs becoming a ROD. These data provide a platform to inform future interventions designed to increase AAs becoming a ROD at the DMV.

A Department of Motor Vehicle-Based Intervention to Promote Organ Donor Registrations in New York State

CONTEXT

Examination of efficacy of motor vehicle representative educational training and dissemination of promotional materials as a means to promote organ donation enrollments in New York State.

OBJECTIVE

To increase the number of New York State residents who consent to donation through the department of motor vehicle transactions during project period.

SETTING

County-run motor vehicle offices across New York State.

PARTICIPANTS

Customers who present to New York Department of Motor Vehicle offices and the representative who work at designated bureaus.

INTERVENTIONS

point-of-decision materials including promotional posters, brochures, website, and the motor vehicle representative training sessions.

MAIN OUTCOME MEASURES

Reasons for enrollment decision, knowledge/experience with donation, monthly consent rates, enrollment in state organ, and tissue registry.

RESULTS

Customers who elected not to register reported no reason or uncertainty surrounding enrollment. The representatives reported experience with donation, discussion with customers, and need for additional education on organ donation. Enrollment cards were mailed to 799 project staff; counties where offices participated in intervention did not indicate significantly higher monthly enrollments when comparing pre- to postenrollment rates.

CONCLUSIONS

Use of point-of-decision materials and enrollment cards proved inexpensive method to register customers with a 3.6% return rate. Customers report low (27%) enrollment rate and reticence to consent to donation. Educational training sessions with representatives did not yield significant enrollment increases when evaluating data at county-level enrollment.

Source and Message Framing Considerations for Recruiting Mature Adults as Organ Donors Through Direct Mail Campaigns

Context:

Mature adults represent an important audience segment for organ donation practitioners. Despite their potential impact as organ donors, compared to other age demographics, their registration rates are much lower.

Objective:

The objective of the current campaign was to determine the most effective source and message strategy to promote organ and tissue donation among mature adults.

Methods:

A 2 (states: Illinois and Iowa) by 2 (sources: government agency and organ procurement organization [OPO]) by 3 (taglines: Any age is the right age to share the gift of life, Don’t rule yourself out, and Don’t rule yourself out: Any age is the right age to share the gift of life) between-subjects design was used to test the effectiveness of direct mailings promoting organ donation to mature adults.

Results:

Across both Illinois and Iowa, the results revealed that greater organ donation registration rates emerged following exposure to direct mail authored by a state official such as the Illinois Secretary of State or the Iowa Department of Public Health compared to local OPOs.

Conclusions:

Overall, the findings speak to the effectiveness of direct mail marketing campaign’s ability to register potential organ donors. Moreover, the results reveal that it is more important who sends the message as opposed to what the message states.

Does Social Capital Explain Community-Level Differences in Organ Donor Designation?

POLICY POINTS

The growing shortage of life-saving organs has reached unprecedented levels, with more than 120,000 Americans waiting for them. Despite national attempts to increase organ donation and federal laws mandating the equitable allocation of organs, geographic disparities remain. A better understanding of the contextual determinants of organ donor designation, including social capital, may enhance efforts to increase organ donation by raising the probability of collective action and fostering norms of reciprocity and cooperation while increasing costs to defectors. Because community-level factors, including social capital, predict more than half the variation in donor designation, future interventions should tailor strategies to specific communities as the unit of intervention.

CONTEXT

The growing shortage of organs has reached unprecedented levels. Despite national attempts to increase donation and federal laws mandating the equitable allocation of organs, their availability and waiting times vary significantly nationwide. Organ donor designation is a collective action problem in public health, in which the regional organ supply and average waiting times are determined by the willingness of individuals to be listed as organ donors. Social capital increases the probability of collective action by fostering norms of reciprocity and cooperation while increasing costs to defectors. We examine whether social capital and other community-level factors explain geographic variation in organ donor designation rates in Massachusetts.

METHODS

We obtained a sample of 3,281,532 registered drivers in 2010 from the Massachusetts Department of Transportation Registry of Motor Vehicles (MassDOT RMV). We then geocoded the registry data, matched them to 4,466 census blocks, and linked them to the 2010 US Census, the American Community Survey (ACS), and other sources to obtain community-level sociodemographic, social capital (residential segregation, voter registration and participation, residential mobility, violent-death rate), and religious characteristics. We used spatial modeling, including lagged variables to account for the effect of adjacent block groups, and multivariate regression analysis to examine the relationship of social capital and community-level characteristics with organ donor designation rates.

FINDINGS

Block groups with higher levels of social capital, racial homogeneity, income, workforce participation, owner-occupied housing, native-born residents, and white residents had higher rates of organ donor designation (p < 0.001). These factors remained significant in the multivariate model, which explained more than half the geographic variance in organ donor designation (R(2) = 0.52).

CONCLUSIONS

The findings suggest that community-level factors, including social capital, predict more than half the variation in donor designation. Future interventions should target the community as the unit of intervention and should tailor messaging for areas with low social capital.

A Content Analysis of Organ Donation Stories Printed in U.S. Newspapers: Application of Newsworthiness

The current study applied a theory of newsworthiness to the topic of organ donation. Specifically, content analysis of newspaper stories published in the United States (N = 1,988) was performed to identify whether deviance and significance of a story predicted story prominence, measured as story length and placement in the newspaper. Results indicated support for study hypotheses: Longer stories and front-page stories pertaining to organ donation were more deviant and more significant in content. Analyses also indicated stories more negative in nature were more likely given front-page coverage, represented international events, and were high on deviance and significance. Higher circulating newspapers were more likely to publish stories recounting negative events in organ donation. Results indicated organ donation coverage represents a valid application of newsworthiness theory, and implications of study findings are discussed in relation to the agenda-setting function of news stories.