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.