In this cluster randomized trial, we found that a brief video addressing the concerns of ethnic groups about organ donation increased consent to donate organs among white and black participants as measured by donor status on driver’s licenses, learner’s permits, or state identification cards. The video intervention also resulted in favorable changes in perceptions of donation.
We searched PubMed for the terms organ donation
to identify trials published between 1982 and 2011 that evaluated interventions to increase organ donation. We identified 8 such efforts that either showed no effect or were limited by nonrandomized designs or a lack of validation of self-reported willingness to donate by examining driver’s licenses (13
). For example, a randomized, controlled trial involving 9 churches found that educational materials tailored toward black adults did not differ from standard educational materials in increasing consent for donation on licenses or separate donor cards (13
). However, 1 study that used a pre–post design found increases in willingness to donate and willingness to join a donor registry among visitors to a Web site designed to educate visitors on organ donation (14
). Using a similar method and intervention, another study randomly assigned 490 high school students from 81 schools in Michigan to view either a Web site on organ donation education or one designed to educate viewers on avoiding the common cold (15
). Twenty-two percent of those in the intervention group contacted the Michigan donor registry compared with 16% in the control group (P <
0.07). A multifaceted print and video intervention among American Indians resulted in a 20% increase in consent for donation in a pre–post design (16
). In addition, a workplace intervention involving employees at 21 corporations resulted in a 14% increase in self-reported willingness to donate (18
). In a different pre–post design study, a 14% increase in rates of organ donor registration was also found in counties with motor vehicle bureau staff who attended a 1-hour training program on organ donation compared with counties that used untrained staff (19
). Among town hall meetings in which participants were exposed to a 1-hour lecture on organ donation and offered monetary or raffled prize incentives, persons who were randomly assigned to have organ donor registration forms collected at the end of the meeting had a greater registration rate than those who were given the option to mail their forms (21
). Finally, a randomized, controlled trial conducted in an intensive care unit found that using collaborative requesting with an organ procurement officer and physician was not superior to requests from a physician alone in increasing organ donation rates (20
Our video intervention targeted several barriers to donation that we and others have identified. First, people are generally reluctant to consider their own mortality (22
). Second, many individuals are concerned that they may receive substandard care or prematurely be declared dead if they carry a donor card (24
). Third, distrust of the medical establishment, religious concerns, and a desire for body integrity for burial may be impediments to organ donation (4
). Fourth, many persons are simply not exposed to the topic of donation (25
). Our video specifically addressed these barriers while also emphasizing the positive effects of donation. This combination has been suggested as a promising approach to increasing donation rates (25
Advantages of our video intervention include low cost, brevity, and ease of implementation. The potency of the intervention may have been enhanced by provision of relevant, targeted information just before individuals were required to declare their organ donation status. The use of iPods with noise-cancelling headphones allowed the video to be privately viewed without distractions.
In this study, 9% of participants were not asked about their willingness to donate by BMV staff. During interviews with patrons after they obtained their licenses, many were disconcerted that they had not been asked. This omission reflects a potential missed opportunity to increase organ donation consent. Organ procurement organizations in Ohio and the Minority Organ Tissue Transplant Education Program have been working on addressing this issue (Bowen G, Robinson M. Personal communication.), and this should be an area of focus in subsequent donation interventions at the BMV.
Several limitations must be considered in interpreting our results. Because we compared the video intervention with no intervention, we cannot determine which component of the intervention (the video, the iPod, or both) was responsible for the increased consent for donation. Members of the study staff were not blinded to study group and may have interacted with members of each group differently. The study results may not be generalizable beyond northeastern Ohio. The proportion of control participants who consented to organ donation (71%) was higher than that reported in the general population (about 50%) (10
), suggesting that individuals who were more interested in organ donation may have been more likely to participate in the study. Despite this possibility, a higher proportion of intervention participants consented to organ donation than control participants. In the intervention group, 34% of participants reported still lacking sufficient information about organ donation. This suggests areas of further intervention to increase donation. Similarly, the intervention did not seem to affect participant trust that organs would be distributed fairly. This may represent a ceiling effect (because both groups reported <12% distrust) or an area that was not sufficiently addressed by the video. The video did not seem to increase distrust because there was no difference in distrust between the 2 groups. On average, participants were younger than the general population and thus the intervention may not be generalizable to older groups. We could not determine why 50 participants withdrew or declined to show their licenses. Although we spec-ified racial subgroups in advance, we considered the analyses of racial subgroup and of secondary outcomes exploratory and hypothesis-generating rather than confir-matory. Finally, and perhaps most important, no evidence exists on how or whether the increase in organ donation consent seen in this trial might translate into a greater future supply of organs in the region.
In summary, we found that a brief video intervention delivered on an iPod at the point where BMV patrons were asked to decide organ donor status increased consent for donation. Because tens of millions of Americans obtain driver’s licenses annually, this approach has the potential to substantially increase the number of potential organ donors (27
). Future research should explore the effects of video interventions to increase organ donation in other settings and by using other forms of delivery.