Organ Donor Registration Research Articles

Amendments to the Transplantation Act and impact on the donor situation in Germany

Seit Jahrzehnten besteht in Deutschland ein Mangel an Spenderorganen, 2017 erreichte die Zahl der Organspender einen historischen Tiefstand. Eine sorgfältige Analyse der Ursachen zeigte u. a. strukturelle Defizite in der Spendererkennung und -meldung und veranlasste die politisch Verantwortlichen zum Handeln. Am 01.04.2019 trat das Gesetz zur Verbesserung der Zusammenarbeit und der Strukturen in der Organspende in Kraft, das insbesondere die Rolle der Transplantationsbeauftragten in den Entnahmekrankenhäusern stärkt und für eine aufwandsgerechte Finanzierung der organspendebezogenen Aufgaben der Entnahmekrankenhäuser sorgt. Gleichzeitig wird die Kooperation der Transplantationsbeauftragten mit der Koordinierungsstelle gefördert. Um die Auseinandersetzung mit dem Thema Organspende in der Bevölkerung zu fördern, folgte am 16.01.2020 das Gesetz über die Stärkung der Entscheidungsbereitschaft bei der Organspende. Die Umsetzung der verschiedenen Einzelmaßnahmen der beiden Gesetze wird von einem Gemeinschaftlichen Initiativplan Organspende begleitet. Die rechtlichen Bestimmungen und deren praktische Umsetzung werden ausführlich dargestellt.

Respect, Interaction, and Immediacy: Addressing the Challenges Associated With the Different Religious and Cultural Approaches to Organ Donation in Australia.

Australia is a multicultural society of just over 25 million people, with approximately 310 different ancestries, 300 languages, and 150 religions. This diversity suggests that Australia's people might hold a multiplicity of beliefs regarding organ donation. Research shows that most people in Australia have a strong, positive perception of organ donation; they believe that organ donation helps others and benefits society. However, the current rate of 21.6 donors per million population is below expectations and below the demand for organs needed for transplantation. This has led us to ask whether donation consent rates are differentiated by religious and cultural affiliation. We present a case study of New South Wales, Australia, to address this issue. New South Wales is the most populous state in Australia and is also religiously and culturally diverse. Donation consent data (2016-2019) by ethnicity and by religion show that donation consent rates have improved but not across all groups. Initiatives to increase awareness and support for organ and tissue donation among culturally and linguistically diverse and Aboriginal and Torres Strait Islander communities are discussed. Research is also presented that investigates whether registration rates on the Australian Organ Donor Register can be increased and the implications of this for increasing consent for donation. This research underscores the importance of respecting the diversity of beliefs held regarding organ donation, both positive and negative; offering all people a face-to-face interaction opportunity to consider their beliefs about organ donation, ask questions, and raise concerns without judgment; and providing people with an immediate opportunity to register their donation decision on the Australian Organ Donor Register. The challenges associated with adopting these initiatives are considered along with the role of religious and cultural leaders within the context of organ donation and registration; the unspoken concerns of cultural and religious groups are also addressed. In conclusion, we propose that the rich diversity of Australian society is more of a backdrop than a barrier to organ donation.

A Clustered Randomized Trial Informing Patients on Dialysis About Their Ability to Donate Organs and Tissues.

The transplant waiting list exceeds the number of organs available. One means of increasing the organ pool is to broaden potential donors to include those with chronic diseases. The study tested the effectiveness of using peer mentors to encourage individuals on dialysis to enroll on an organ donor registry. Dialysis units were pair-matched by size and racial composition and then randomized to one of 2 interventions: meetings with a peer mentor (experimental intervention) or organ donation mailings (control). Peer mentors were trained to discuss organ donation with individuals on dialysis during in-person meetings at dialysis units. The primary outcome was verified registration in the state's donor registry. After adjusting for age, gender, race, income, and education and accounting for correlation within the dialysis center, there was a significant intervention effect. Among individuals in the intervention group, the odds of enrolling (verified) on the donor registry were 2.52 times higher than those in the control group. The use of peer mentors to discuss donating organs after death with individuals on dialysis can increase enrollment on a donor registry. Dispelling myths about chronic illness and donation can counter widely held misconceptions and help persons make an informed choice about end-of-life decisions and present an opportunity to increase the number of organs and tissues available for transplant.

Passive-positive organ donor registration behaviour

Passive-positive organ donor registration behaviour

Awareness on Organ Donation among Urban and Rural Communities in Bintulu

In Malaysia, the number of registered organ donors are relatively small in comparison to other countries. This study aimed to investigate the awareness, knowledge and practices on organ donation among public in Sarawak. A cross-sectional study was conducted in urban and rural parts of Bintulu, Sarawak. Questionnaires consisting of socio-demography (5 items), awareness (4 items), knowledge (6 items) and practice (5 items) questions were distributed using random and snowball sampling techniques. A total of 327 respondents (age = 33.27 ±10.06 years; urban area = 50.2%; male = 59.0%; Christian = 48.9%; Bumiputra Sarawak = 53.2%) were enrolled. Urban respondents have demonstrated better knowledge (definition = 24.1% vs 23.6%; treatment = 42.2% vs 41.6%; side effects = 45.2% vs 32.9%; from living donor = 80.1% vs 70.8%; from dead donor = 71.7% vs 53.4%; organs can be donated = 19.9% vs 27.3%) compared to rural respondents. Urban respondents possessed better awareness (awareness = 86.1% vs 73.9%; source of information = 39.2% vs 31.7%; need = 70.5% vs 50.3%) than their counterparts. Subsequently, urban respondents reported better practice (agree = 68.7% vs 60.2%; registered = 2.4% vs 1.2%; donate after death = 27.7% vs 25.5%; without permission = 20.5% vs 18.0%; for loved ones = 72.9% vs 64.6%) than rural respondents. Conclusion: Population in urban area are more aware, have higher knowledge and better practice regarding organ donation. Health education on organ donation should be encouraged specifically among rural residents to enhance the number of registered organ donors in Malaysia.

When Lone Wolf Defectors Undermine the Power of the Opt-Out Default

High levels of cooperation are a central feature of human society, and conditional cooperation has been proposed as one proximal mechanism to support this. The counterforce of free-riding can, however, undermine cooperation and as such a number of external mechanisms have been proposed to ameliorate the effects of free-riding. One such mechanism is setting cooperation as the default (i.e., an opt-out default). We posit, however, that in dynamic settings where people can observe and condition their actions on others’ behaviour, ‘lone wolf’ defectors undermine initial cooperation encouraged by an opt-out default, while ‘good shepherds’ defeat the free-riding encouraged by an opt-in default. Thus, we examine the dynamic emergence of conditional cooperation under different default settings. Specifically, we develop a game theoretical model to analyse cooperation under defaults for cooperation (opt-out) and defection (opt-in). The model predicts that the ‘lone wolf’ effect is stronger than the ‘good shepherd’ effect, which – if anticipated by players – should strategically deter free-riding under opt-out and cooperation under opt-in. Our experimental games confirm the existence of both ‘lone wolf’ defectors and ‘good shepherd’ cooperators, and that the ‘lone wolf’effect is stronger in the context of organ donation registration behaviour. We thus show a potential ‘dark side’ to conditional cooperation (‘lone wolf effect’) and draw implications for the adoption of an opt-out organ donation policy.

Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis—protocol

IntroductionThe need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a...

'Would you like to join the NHS Organ Donor Register?' A general practice feasibility study.

A shortage of organ donors exists in the UK and targeting family consent is key for increasing donation consent rates. Registration on the NHS Organ Donor Register (NHS ODR) facilitates this, as it guides families on their loved ones donation preference. In general practice, an opportunity to register is provided, however only to new patients. To improve access to registration opportunities, an intervention was designed where general practice staff asked their patients if they wished to register as an organ donor. To assess an organ donation registration intervention for feasibility and acceptability in a UK general practice setting. One general practice, in Luton, UK, conducted the intervention for 3 months (April to July 2018). Training was held in March 2018, and leaflets and posters were displayed for the 3-month period. An embedded experimental mixed-methods design was used, with data collected via SystmONE questionnaires, surveys and focus groups. The intervention was found to be feasible and acceptable to conduct with some patients by some staff members. During the 3 months, patients were asked in 12.4% of face-to-face consultations (n=812). Nurses and healthcare assistants were more able to conduct the intervention than doctors. Lack of time, telephone consultations, and it not being appropriate were the most common reasons for not asking. Finally, 244 patients joined the NHS ODR; 30.4% of those asked. This study demonstrates that general practice could be a feasible location in which an intervention designed to increase NHS ODR registration could be conducted.

Attitudes, acceptance, and registration in relation to organ donation in Hong Kong: a cross-sectional study.

The objective of this study was to investigate the discrepancy between individuals with positive attitudes towards organ donation and the actual number of registered organ donors in Hong Kong, and to investigate the best modalities for promoting more organ donor registrations. This cross-sectional telephone survey was conducted in Hong Kong. Telephone numbers were selected randomly. Upon successful contact with a household, the eligible household member who had the most recent birthday was selected to participate in the telephone interview. A total of 1000 Hong Kong Chinese residents were interviewed successfully. The response rate was 53.8%. The majority of the respondents were female (68.3%) and were aged 51 to 60 years (24%) or ≥61 years (43.6%). Among the respondents, 31.3% were willing to donate their organs after death; 43.3% were indecisive, and 25.4% refused. Among those who were willing to donate organs after death, only 34.2% had registered with the Centralised Organ Donation Register (CODR). Among those who were willing to donate organs after death but had not yet registered on CODR, 52.2% said they were not determined enough to take action, 47.8% said they were too busy, 37.8% said they were too lazy, and 20.4% said they were always forgetful about registering. In all, 32.8% of the interviewees were not aware of the ways to register as a prospective organ donor. Among non-messenger social media platforms, Facebook, YouTube, and Instagram were the most commonly used. Most participants believed that Facebook and YouTube were effective for engaging audiences. More effort should be made to facilitate organ donor registration in face-to-face settings via promotional booths and in online settings via appropriate social media platforms.

Implementation of an interactive organ donation education program for Dutch lower-educated students: a process evaluation

BackgroundAs organ donation registration rates remain low, especially among lower-educated people, it is important to support this group in making their registration decision. To prepare lower-educated students in the Netherlands for making a well-informed decision, an interactive educational program was developed. We aim to understand both the (quality of) implementation as well as to contextualize the effects of this program in a lower-educated school setting.MethodsThe process evaluation was part of a Cluster Randomized Controlled Trial, in which 11 schools for Intermediate Vocational Education throughout the Netherlands participated. Teachers who taught a course on Citizenship delivered three intervention elements (i.e. video fragments and discussion, quizzes with tailored feedback and an exercise filling out a registration form) to their students. Implementation was assessed by interviews with teachers, questionnaires from students, logbooks from teachers and user data from Google Analytics.ResultsThe program was well received and implemented, but on-the-spot adaptations were made by teachers to fit their students better. Within the lower-educated target group, differences between students are high in terms of active participation, reading abilities, knowledge and attention span. The program fit well within their regular teaching activities, but the topic of organ donation is not always prioritized by teachers.ConclusionsWe see opportunities to disseminate the program on a larger scale and reach a group that has been neglected in organ donation education before. Within the program, there are possibilities to increase the effectiveness of the program, such as alternative delivery methods for the elements with a lot of text, the addition of booster sessions and guidelines for teachers to adapt the program to students of different levels within Intermediate Vocational Education. Moreover, in order to have an impact on a national level, strategies need to be employed to reach high numbers of students and, therefore, support on a higher level is needed (both within schools and at policy level).Trial registrationDutch Trial Register, NTR6771. Prospectively registered on 24 October 2017.

The Effect of Positive and Negative Poster Messages on Organ Donor Registration

BackgroundThere is a mismatch between the number of people who require transplants and the number of organ donors. Promotional materials have been shown to increase rates of organ donor registration. This study assessed the impact on the intention to join the organ donor registry of a gain-framed message about lives saved through organ donation compared to a loss-framed message about lives lost waiting for a transplant. MethodsTwo posters were designed that were identical other than the slogan. One slogan was gain-framed: “One organ donor can save 9 lives!” and the other loss-framed: “3 people die every day in the UK waiting for an organ transplant.” Twenty copies of each were distributed between hospitals in Cambridge and Newcastle, UK, for 20 weeks. After 10 weeks, the gain-framed and loss-framed posters swapped locations. Each poster had a QR code that linked to the online organ donor register sign-up form, and the click-through rate was used to determine registration. Analysis was performed using a 2-tailed sign binomial test. ResultsSixty-eight registrations occurred over a 20-week period. Overall, there was no significant difference in registrations between gain- and loss-framed posters (37 vs 31, P = .54). However, poster location influenced registration, as prior to the location swap there was a significant difference in gain-framed vs loss-framed posters (28 vs 10, P = .005). Additionally, registration was significantly higher in Cambridge vs Newcastle (47 vs 21, P = .01). ConclusionsPosters can increase organ donor register (ODR) registration independent of gain- or loss-framing. However, poster location, both intra- and inter-hospital, significantly influences effectiveness.

Improving access to organ donor registration in general practice: a feasibility study.

Organ donor registration helps guide decision making for families. UK general practice provides the facility to register on the NHS Organ Donor Register, but only to new patients. An intervention was developed to present a registration opportunity to existing patients in this setting. To assess the feasibility and acceptability of an organ donation intervention implemented in UK general practice. The intervention ran in a large practice in Luton in the UK, for 3 months in 2018. A single practice feasibility study was conducted using an embedded experimental mixed methods design. Staff were trained to ask patients in consultations if they wished to join the register, and leaflets and posters were displayed in the waiting room. Data on feasibility and acceptability were captured using SystmONE questionnaires, surveys, and focus groups. Over 3 months, in 12.4% of face-to-face consultations, patients were asked if they would like to join the register (812 of 6569), and 244 (30.0%) of these patients joined the register. Common reasons staff did not ask patients were due to telephone consultations, lack of time, and it not being appropriate. Nurses and healthcare assistants performed prompted choice more than doctors (23.4%, 17.1%, and 1.6% respectively). Certain clinic types, such as phlebotomy or routine clinics, facilitated asking compared to those where patients presented with unknown or more serious issues. The intervention was found to be feasible and acceptable by some staff and patients. Feasibility criteria were met; therefore, the intervention can progress to further testing.

Abstract 16: Sex Disparities in Organ Donation: Finding an Equal Donor Pool

Introduction: The majority of living organ donors are women, and the majority of deceased organ donors are men. This poses a problem for transplant candidates who have worsened survival with sex mismatched organs. The objective of this study was to identify reasons for disparities in organ donation between sexes and identify strategies to increase organ donors. Methods: We conducted a fifteen question survey using a crowdsourcing marketplace, Amazon’s Mechanical Turk, in September 2019. The survey assessed how participants make decisions about becoming an organ donor. The survey was distributed to U.S. adult participants, including eight write-in questions and two Likert scale questions. Qualitative descriptive analyses were used to understand reasons for and against becoming an organ donor. Quantitative results were compared with t test. Results: Among the 667 eligible participants representing 49 states, 54.9% were women and 63.1% were in the 18-40 age group. The majority of men (64.8%) and women (63.4%) were registered organ donors. Among men and women donors, three themes guided their willingness to donate: desire to help others, personal experience with organ donors/recipients, and believing organs would have no use to the donor once dead. Among men and women non-donors, decisions were guided by three themes: no reason, medical mistrust, considering becoming a donor. Themes varied by sex when considering whether to donate organs of a deceased family member. Women were guided equally by two themes: family member’s wishes and believing the deceased family member had no further use for organs. Men had similar themes but valued the family member’s wishes more. Women’s willingness to donate their own organs to family members (p=0.03) and strangers (p=0.02) was significantly higher than men. Among non-donors, both sexes would consider becoming organ donors if more information was provided. Conclusion: In a national survey of adults, women and men had similar reasons for becoming and not becoming an organ donor. However compared to men, women were more willing to donate their organs and more altruistic in the donation of family members’ organs. Women’s deceased organ donation may increase with further communication of women’s wishes before death and by improved public education about organ donation.

A Video Intervention to Increase Organ Donor Registration at the Department of Motorized Vehicles

The goal of this study was to increase organ donor registrations at the Department of Motorized Vehicles (DMV) via utilization of a sustainable, low-cost, African American-centric organ donation educational video. Results from previous studies provided a framework to generate a 10-minute video that featured registered organ donors, deceased donor families, and transplant recipients. The video was presented via an interrupted time series design (repeating on 2 mo, off 2 mo) on televisions placed in 6 regional DMVs. During the 12-month study, 162 387 patrons visited the DMVs. Increases in organ donor registration were consistently observed in each DMV while the video was on compared with off (mean = +2.3% [range +1.98% to +3.35%]; P < 0.0001). Multivariable analysis demonstrated that females (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.26-1.31), younger age (OR, 0.982/y; 95% CI, 0.982-0.983), and the video intervention (OR, 1.09; 95% CI, 1.07-1.12) were significantly associated with increased registration; while compared with Caucasian race, African American race was not (OR, 0.22; 95% CI, 0.22-0.23). There was no video-dependent effect on registration between Caucasians and African Americans (P = 0.62). Exit interviews demonstrated only 16% of patrons could identify the key message in the video (becoming a registered organ donor). An educational video promoting organ donation resulted in increased organ donor registration at the DMV. The intervention was equally effective in African Americans and Caucasians. Future efforts should focus upon target-specific messaging and patron consumption of the educational video.

Organ Procurement and Extrajudicial Execution in China: A Review of the Evidence

The Victims of Communism Memorial Foundation (VOC) has conducted a detailed examination of the allegations of extrajudicial killing for the harvesting of organs by the Chinese Communist Party and the evidence underlying these allegations. The report was produced by VOC China Studies Research Fellow Matthew P. Robertson, a doctoral researcher whose work using statistical forensics to demonstrate the falsification of Chinese organ donor registry data was recently published in the leading journal of medical ethics, BMC Medical Ethics. The report contributes to the literature and policy discussion on coercive organ transplant practices in China in several ways: it presents new primary documentary research and original datasets, integrates established scholarship on China’s death penalty system, and situates previously published works on organ harvesting within a careful discussion of counterfactual scenarios and scientific inference. It also serves as a roadmap to the debate about and evidence of extrajudicial killing for organs in China, while also critically engaging with how that evidence has been interpreted and received. The report challenges international complacency on the topic by examining the signs of ongoing organ trafficking, highlighting the falsification of official datasets, and analyzing the evidence that Uyghur Muslims may be the latest victims of this form of state predation. In examining the extraordinary growth of organ transplantation and rapid availability of organs in China, the report asks one overarching question: What is the most plausible explanation for the source of the organs? The report examines the evidence of blood-testing and medical examinations of Falun Gong practitioners and Uyghurs in custody, and finds that extrajudicial organ sourcing from these populations is the most plausible and parsimonious explanation. As such, readers should adopt it as empirically adequate until either a better explanation or reliable data inconsistent with the hypothesis emerges.

'It's like being conscripted, one volunteer is better than 10 pressed men': A qualitative study into the views of people who plan to opt-out of organ donation.

ObjectivesTo overcome the shortage of organ donors, Scotland and England are introducing an opt‐out organ donor registration system in 2020. This means individuals will be automatically considered to consent for donation unless they actively opt‐out of the register. Research has found that emotional barriers play a key role in donor decisions under opt‐in legislation, yet little is known about factors that influence donor decisions under opt‐out consent. Our objectives were to investigate attitudes towards organ donation and opt‐out consent from individuals who plan to opt‐out, and to explore the reasons why they plan to opt‐out.DesignQualitative interview study.MethodsSemi‐structured interviews were conducted with 15 individuals from Scotland (n = 14) and England (n = 1) who self‐reported the intention to opt‐out of the register following the legislative change to opt‐out. The interviews were transcribed verbatim and analysed using thematic analysis.ResultsThree main themes were identified: (1) consent versus coercion, which describes the perception of freedom of choice under an opt‐in system and fears of ‘government interference’ and threatened autonomy under opt‐out, (2) self‐protection, encompassing fears of medical mistrust, bodily integrity concerns, and apprehension regarding the recipient selection process, and lastly, (3) ‘riddled with pitfalls’, which includes the notion that opt‐out consent may increase susceptibility of stigma and reproach when registering an opt‐out decision.ConclusionsThis study reinforces existing opt‐in literature surrounding medical mistrust and bodily integrity concerns. A threat to one’s autonomous choice and heightened reactance arising from perceptions of unwarranted government control have emerged as novel barriers. Statement of contribution What is already known about this subject? Although around 90% of individuals in the United Kingdom support organ donation, just 40% are actively registered as donors. As part of measures to improve rates of organ transplantation, Scotland and England are moving to an opt‐out organ donation consent system in 2020.Existing research has shown that feelings and emotions are important factors that influence donor relevant decisions under the current opt‐in system, but little research has explored potential deterrents under the new plans for opt‐out consent.Minimizing the number of people opting out of the donor register is key to ensure sustained rates of transplantation. What does this study add? This study explored why people plan to opt‐out of the new system in Scotland and England.Medical mistrust and bodily integrity concerns remain as salient barriers under opt‐out laws.Fears of unwarranted government control and a perceived threat to one’s freedom of choice emerged as a novel barrier.

Utilizing a Hospital-based Setting to Increase Organ Donor Registrations.

Shortages of organs for transplantation are a concern for many countries. In Australia's "opt-in" system, people register their donation decision on the Australian Organ Donor Register (AODR) in their own time, yet <30% of the population have done so. Consent registrations are honored by the next-of-kin in 90% of cases, so increasing registrations will increase donated organs for transplantation. This study investigated the efficacy of offering an immediate registration opportunity in 2 hospitals, and the role that beliefs about organ donation play in registration behavior. An immediate registration opportunity was offered at a public and a private hospital in New South Wales, Australia. Participants (N = 168) categorized as medical/healthcare (eg, doctor and nurse) and nonhealthcare (eg, teacher and chef) completed a measure of beliefs about organ donation, were encouraged to discuss their fears and concerns about organ donation, and given an immediate opportunity to register on the AODR. A total of 81.5% of medical/healthcare participants who were eligible registered, and 71.5% of all eligible participants registered on the spot. Beliefs about the negative consequences of donation and concerns over the medical care given to potential donors predicted (non)registration. Medical/healthcare participants reported lower levels of fears and concerns than nonhealthcare participants. Although both groups reported strong positive beliefs about donation, these did not predict registration. Offering an immediate registration opportunity in 2 hospitals notably increased the number of registrations on the AODR, suggesting this is a strategy that could potentially increase registrations in opt-in donation systems.

Solid organ donation after death in the United States: Data-driven messaging to encourage potential donors.

US deceased donor solid organ transplantation (dd-SOT) depends upon an individual's/family's altruistic willingness to donate organs after death; however, there is a shortage of deceased organ donors in the United States. Informing individuals of their own lifetime risk of needing dd-SOT could reframe the decision-making around organ donation after death. Using United Network for Organ Sharing (UNOS) data (2007-2016), this cross-sectional study identified (1) deceased organ donors, (2) individuals waitlisted for dd-SOT (liver, kidney, pancreas, heart, lung, intestine), and (3) dd-SOT recipients. Using US population projections, life tables, and mortality estimates, we quantified probabilities (Pr) of (1) becoming deceased organ donors, (2) needing dd-SOT, and (3) receiving dd-SOT. Lifetime Pr (per 100000 US population) for males and females of becoming deceased organ donors were 212 and 146, respectively, and of needing dd-SOT were 1323 and 803, respectively. Lifetime Pr of receiving dd-SOT was 50% for males, 48% for females. Over a lifetime, males were 6.2 and females 5.5 times more likely to need dd-SOT than to become deceased organ donors. Organ donation is traditionally contextualized in terms of charity toward others. Our analyses yield a new tool, in the form of quantifying an individual's own likelihood of needing dd-SOT, which may assist with reframing motivations toward deceased donor organ donation.

A Data-Driven Social Network Intervention for Improving Organ Donation Awareness Among Minorities: Analysis and Optimization of a Cross-Sectional Study.

BackgroundIncreasing the number of organ donors may enhance organ transplantation, and past health interventions have shown the potential to generate both large-scale and sustainable changes, particularly among minorities.ObjectiveThis study aimed to propose a conceptual data-driven framework that tracks digital markers of public organ donation awareness using Twitter and delivers an optimized social network intervention (SNI) to targeted audiences using Facebook.MethodsWe monitored digital markers of organ donation awareness across the United States over a 1-year period using Twitter and examined their association with organ donation registration. We delivered this SNI on Facebook with and without optimized awareness content (ie, educational content with a weblink to an online donor registration website) to low-income Hispanics in Los Angeles over a 1-month period and measured the daily number of impressions (ie, exposure to information) and clicks (ie, engagement) among the target audience.ResultsDigital markers of organ donation awareness on Twitter are associated with donation registration (beta=.0032; P<.001) such that 10 additional organ-related tweets are associated with a 3.20% (33,933/1,060,403) increase in the number of organ donor registrations at the city level. In addition, our SNI on Facebook effectively reached 1 million users, and the use of optimization significantly increased the rate of clicks per impression (beta=.0213; P<.004).ConclusionsOur framework can provide a real-time characterization of organ donation awareness while effectively delivering tailored interventions to minority communities. It can complement past approaches to create large-scale, sustainable interventions that are capable of raising awareness and effectively mitigate disparities in organ donation.

A Culturally Targeted eLearning Module on Organ Donation (Promotoras de Donación): Design and Development.

BackgroundAs an overrepresented population on the transplant waitlist, stagnated rates of organ donation registration among Latinxs must be redressed. Promotoras (community health workers), who are effective at advocating and spearheading health promotion efforts in the Latinx community, show promise in their ability to educate about organ donation and donor registration.ObjectiveThis study aimed (1) to develop an interactive, evidence-based program to educate promotoras about organ donation, the need for organ donors in the Latinx American community, and ways to register as deceased organ donors and (2) to train promotoras to lead discussions about organ donation and to promote the act of donor registration.MethodsIn partnership with 4 promotoras organizations, the culturally targeted Promotoras de Donación eLearning module was developed based on input from 12 focus groups conducted with Latina women (n=61) and promotoras (n=37). Formative work, existing literature, the Vested Interest Theory, and the Organ Donation Model guided curriculum development. In partnership with the Gift of Life Institute and regional promotoras, the curriculum was designed, filmed, and developed in a visually appealing module interface. The module was beta-tested with promotoras before launch.ResultsPromotoras de Donación, available in Spanish with English subtitling, lasts just over an hour. The module comprised 6 sections including various activities and videos, with the curriculum divided into a skills-based communication component and a didactic educational component. Pre- and posttests assessed the module’s direct effects on promotoras’ organ donation knowledge and attitudes as well as confidence promoting the act of donor registration.ConclusionsThis novel, theoretically and empirically based intervention leveraged the existing network of promotoras to promote the act of donor registration. Future research should assess whether the module helps increase rates of donor registration within Latinx communities and reduce disparities in access to transplantation.Trial RegistrationClinicalTrials.gov NCT04007419; https://www.clinicaltrials.gov/ct2/show/NCT04007419