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The Division of Transplantation in the Health Resources and Services Administration's Office of Special Programs will administer the new program as part of the Clinton Administration's National Organ and Tissue Donation Initiative, launched by Vice President Al Gore and HHS Secretary Donna E. Shalala on Dec. 17, 1997.

HHS has taken several steps over the past 18 months to increase organ donation, and donations did go up 5.6 percent last year, the first increase since 1995.

"In order to achieve new, significant increases, we must not only expand our outreach as we've already done-we must also increase the rate at which families and others consent to donation when asked," said Deputy Secretary Thurm. "This new effort is aimed especially at learning what works best to increase consent rates."

The extramural program will support projects for up to three years to implement and evaluate initiatives to increase organ and tissue donation. Pilot projects will test the effectiveness of promising new "interventions," while replication projects will focus on implementing and testing at expanded or multiple sites those interventions already shown to be effective in more limited trials. All projects must include rigorous evaluation mechanisms. Performance measures are expected to address one or more of the following outcomes: 1) organ procurement, 2) consent rates for organ donation and/or, 3) declaration of intent to donate coupled with family notification of intent to become an organ donor. To look at ways to expand and diversify the donor pool to better meet the needs of those waiting for transplants, projects focusing on consent and variations in consent by race and ethnicity are especially encouraged.

All applications must be submitted by a consortium of at least two organizations, with one having expertise in research and evaluation and the other in donation/transplantation. One agency will be considered the "applicant" and will have overall responsibility for the project. By law, the applicant must be a federally designated organ procurement organization or other nonprofit, private organization. For-profit and public organizations may participate as members of consortia, but not as the applicant.

Consortium members may include such entities as public health or government agencies; academic institutions; hospitals; community or migrant health centers or other health services delivery sites; transplantation or donation-related associations or organizations; patient, donor family, or recipient organizations; or community- or faith-based organizations.

A major barrier to donation today is low rates of family consent; only about half of families who are asked give their consent to organ donation. The latest Gallup poll found that nearly all Americans would consent to donation if they knew their loved one had requested it, but only about half of Americans who want to donate have told their families.

"With more than 63,000 patients waiting for a donated organ, we need to find out what works best to increase organ donations and break down barriers to consent," said HRSA Administrator Claude Earl Fox, M.D., M.P.H. "We're asking organizations to collaborate on model programs with good evaluation protocols so they can be replicated across the country."

Each year, only about 5,500 deaths in the United States result in organ donation, but the estimated potential number of donors per year ranges from 8,000 to 15,000. More than 4,000 patients awaiting a transplant die each year-some 12 to 13 each day-because of the critical shortage of transplantable organs.

The program was outlined in a Federal Register notice on April 5, 1999, with a 30-day comment period. The final grant application guidance is now available on three World Wide Web sites: www.hrsa.gov, www.hrsa.gov/osp/dot and www.organdonor.gov. Applicants will have approximately 60 days to submit applications.

For more information on the new program, write to HRSA's Division of Transplantation at Parklawn Building, Room 4-81, 5600 Fishers Lane, Rockville, Md. 20857; telephone (301) 443-7577, or visit the division's Web site at www.hrsa.gov/osp/dot/. HRSA is the lead HHS agency responsible for improving access to health care for all Americans.

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