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Report on Social and Behavioral
Interventions to Increase Organ Donation Grant Program 1999-2004
Potential Future Directions and Recommendations
for the Division of Transplantation Grant Program
The increasing sophistication of projects funded by DOT is
evident from reviewing recent applications and progress reports.
There are an increasing number of academic-based researchers
who have partnered with OPOs and who have been disseminating
the results of successful programs. This, in turn, has generated
increasing interest among social science researchers to create
new programs. Changes in rules that now allow applications
from non-501c3 organizations mean that researchers can now
act as Principal Investigators on projects, further motivating
them to compete for funding in partnership with OPOs. Because
the success of a project cannot be determined without rigorous
methodological design and evaluation procedures, it is important
that researchers play a more important role in projects than
they had in many earlier projects.
It would also be productive for grant reviewers and OPO professionals
to recognize the interrelationships between different types
of interventions, including hospital-based programs and public
education campaigns. There appears to be a dichotomy in how
interventions are viewed; unfortunately, many people appear
to subscribe to the view that one type of intervention will
have a greater impact on organ donation than the other. As
an example, the Mississippi project with an ostensible focus
on hospital staff justifiably pointed to OPO/requestor issues
that impacted consent rates. More systemic approaches—or at
least, interventions that acknowledge all of the stakeholders
who impact donation—are needed. The figure that appears in
the next section of this report may help to illustrate how
each type of intervention can impact the success of the others.
These recent successes and changes in the DOT grant program
lead to several recommendations for the future. First, rather
than “reinventing the wheel” by funding very similar projects
in different parts of the country, national replication grants
should be awarded to test the applicability of successful
approaches to the entire U.S. (or at least to large regions
of the U.S.). The most expensive element of most projects
generally has been the evaluation component. Research personnel
costs, costs for phone surveys or printing and postage costs
for mail surveys, and incentives to increase response rates
or to encourage project participation have accounted for a
relatively high proportion of total project costs. National
replication grants led by PIs of successful projects would
not need to spend funds on the development of a proposed intervention;
virtually all materials would already be available for immediate
use. Similarly, evaluation procedures could be simplified.
Rather than extensive surveys of knowledge, attitude, and
behavioral intent, evaluation could focus on “hard” behavioral
outcomes, such as increases in DMV donor registry rates, referral
rates, or consent rates at intervention sites. In the case
of hospital-based interventions, the PIs of successful grant-funded
projects could take project materials “on the road” to train
OPO or hospital staff in proven techniques that will increase
donation.
DOT can facilitate the development of innovative new programs
to increase donation by creating an easily accessible website
to host electronic resources, including survey measures, ads,
PSAs, training protocols, school curricula, and “best practices”
documents, including those generated by project staff of successful
interventions. Additionally, where appropriate, providing
access to final reports of completed projects could prove
helpful to prospective applicants who seek to avoid the mistakes
of past projects. These reports may also stimulate ideas for
more innovative approaches to interventions targeting the
same populations or contexts.
This review of programs funded by the Division of Transplantation
have demonstrated that there are a large number of successful
programs which are saving the lives of people on transplant
waiting lists. In some cases, by carefully examining analyses
of project outcomes we can pinpoint exactly how many transplants
were likely to have resulted from a funded program. Longer
funding periods (four to five years rather than the current
three years) would allow us to track long-term effects of
these programs or assess the cumulative effects of interventions
with multiple components. This would add even greater strength
to the findings of the cost-effectiveness of many of the approaches
developed through the DOT program.
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