On approach to addressing the continual shortage of organ donors is to encourage people to join a state donor registry. Joining the registry saves time and assures family members that organ donation is what their loved one would want. However, fewer than half of adults have taken this step. We tested a brief, webbased training program for department of motor vehicles (DMV) staff that educates them about organ and tissue donation and also models the correct way to interact with customers. The intervention was developed with extensive input and active participation from DMV staff. After a small-scale pilot test, all DMV offices across the state of West Virginia (WV) were randomized to receive the training or serve as a comparison group. The results showed that customers of DMV staff who had received the training were 7.5% more likely to register as organ donors. A conservative estimate is that this generates approximately 800 additional donor designations per month. An important aspect of webbased training is that once it has been deployed, it can continue to be used without incurring additional cost; the state of WV currently requires all new employees to complete the training program. This type of training can be adopted nationwide.

Background. This study examines the effect of breakdown in the organ donation process on the availability of transplantable organs. A process breakdown is defined as a deviation from the organ donation protocol that may jeopardize organ recovery. Methods. A retrospective analysis of donation-eligible decedents was conducted using data from an independent organ procurement organization. Adjusted effect of process breakdown on organs transplanted from an eligible decedent was examined using multivariable zero-inflated Poisson regression. Results. An eligible decedent is four times more likely to become an organ donor when there is no process breakdown (adjusted OR: 4.01; 95% CI: 1.6838, 9.6414; P < 0.01) even after controlling for the decedent's age, gender, race, and whether or not a decedent had joined the state donor registry. However once the eligible decedent becomes a donor, whether or not there was a process breakdown does not affect the number of transplantable organs yielded. Overall, for every process breakdown occurring in the care of an eligible decedent, one less organ is available for transplant. Decedent's age is a strong predictor of likelihood of donation and the number of organs transplanted from a donor. Conclusion. Eliminating breakdowns in the donation process can potentially increase the number of organs available for transplant but some organs will still be lost.

Background: There are about 120 000 people on the US waiting list for a solid organ transplant; nearly 22 people die every day who could be helped through organ donation. Joining a donor registry and informing one’s family of one’s preferences increases recovery rates and can avoid misunderstandings during an emotionally difficult time. Although the vast majority of people support organ donation, only about half of adults have joined a state donor registry. Methods. A 3-group design was used. Primary care physician offices were randomly assigned to either web-based training, in-person training, or a control condition. The control condition consisted of a poster and traditional brochure and donor form placed in the waiting room. In the 2 intervention groups, the Patients Save Lives form was distributed during the check-in process in addition to the poster. Results: A total of 1521 physicians and office staff at 81 clinic sites (48 in-person and 33 web-based) received the training; there were 33 control locations. A total of 21 189 patients were exposed to the intervention over a 6-month period; 761 (8.1%) of 9428 people who were not already registered completed the designation form to be organ donors. There were no donor designations in the control group locations. Conclusion: Organ donor designation can be incorporated into the office check-in procedure without disrupting the workflow or burdening clinicians. The program is available online and can be sustained inexpensively with cooperation between primary care offices and regional Organ Procurement Organizations.

Because the cost per registrant and cost per donor is less than society's willingness to pay, donor registry promotion offers positive return on investment. Investment in registry promotion should at the minimum be maintained at current levels.