The Future of Organ Donation in the United States:
Encouraging Americans to Become Donors

Author:

Jenna Williams-Bader - Managing Editor;

(pdf version)

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In 1954, the first successful transplant of a kidney marked the birth of a new kind of medicine: organ transplantation.¹ Transplantation allows doctors to replace failing, diseased organs with healthy, functioning ones, and therefore gives hope, and a new lease on life, to thousands of people every year. In the United States alone, more than 28,000 organs were transplanted in 2005.²

As a field, organ transplantation has had to overcome a number of problems to become the miracle that it is today. In the years following the kidney transplant in 1954, researchers and doctors had to discover how to prevent transplant rejection. The 1954 transplantation was a success because it involved identical twins, a situation in which rejection does not occur. A host of immunosuppressive drugs had to be created before transplant recipients had a chance to escape rejection and survive the surgery.¹

In the 21st century, survival rates for transplant recipients have greatly increased. However, a number of problems still exist. Immunosuppressive drugs have their own health side effects, such as hypertension, diabetes, and perhaps even cancer.¹ And while on an average day, 77 people receive transplants, another 19 die while on the waiting list.³ Since 1988, the number of Americans on the waiting list for organs has increased five times, from 16,000 to more than 90,000 people. Unfortunately, the number of donors has not increased to meet this demand.²

Many organizations are working to increase the number of available donor organs. A 2006 report by the Institute of Medicine examined the issue. The report, Organ Donation: Opportunities for Action, made numerous specific recommendations, including: improving the organ procurement system; increasing organ donation consent from family members of deceased patients; integrating organ donation into standard end-of-life care; increasing donations from cardiac-arrest deaths outside of hospitals; improving state donor registries; creating a national database that is updated and accessible 24/7; and, educating the public about organ donation.²

Two of the case studies in this inaugural volume of Cases describe programs intended to increase the number of organ donors. "Donate Life California: A Campaign Launch Case Study" examines the launch of an online donor registry in California. In the first six months of the campaign, more than 175,000 people registered online to become organ donors. The carefully-crafted, multifaceted campaign included a number of important public health communication and marketing techniques. The campaign team identified specific, concrete target audiences, and developed tailored messages for each audience. They framed organ donation as an essential, simple way to save lives and used news media outreach to good effect by supplying news outlets with information that was engaging and "newsworthy." Recognizing that news coverage could not be sustained, the campaign team cultivated and activated the interpersonal communication influence of key opinion leaders (such as politicians, faith leaders, and members of the medical field) as a means of building community support. This case study nicely demonstrates how precision thinking, creative outreach to the news media, and activation of social influence networks can magnify the impact of a modestly-sized campaign budget.

Bandura's Social Cognitive Theory - and before that his Social Learning Theory - has for decades helped us understand the importance of observation learning: people learn new behaviors by watching other people perform (or model) those behaviors.^4,5 "Motivating Television Viewers to Become Organ Donors" is a wonderful example of how public health professionals can harness the power of television to model health enhancing behaviors. Specifically, the case demonstrates that collaboration with television writers, directors and producers can produce emotionally engaging positive modeling that encourages people to register as donors. Perhaps what is most exciting about this case study is that it reveals how relatively few resources (of both time and money on the part of public health professionals) can disseminate a positive health message into millions of homes.

As the Institute of Medicine report made clear, America's organ donation program must evolve in multiple ways if the supply of organs is ever to keep pace with the need. As the two organ donation case studies in this issue of the journal demonstrate, collaboration between public health professionals, the media and key community members will be essential to creating solutions.

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