Deep Demographics: Understanding Local Variation in Donor Registration.

This is the first published study to examine in detail the demographic factors associated with willingness to register as an organ donor at a state motor vehicles bureau. It uses registration counts controlling for the size of the general population as the measure of willingness. Local variation in registration levels is modeled as a function of a set of local socioeconomic, racial/ethnic, and immigration characteristics; cluster analysis of social areas is used to probe the effects of nonlinear combinations of local social environment factors. Results show that residence in high minority areas, lower-income areas, and immigrant-heavy areas depresses registration levels but also that significant nonlinear combinations of factors are at work. Specifically, minority/immigrant areas tend strongly to have lower registration counts controlling for population regardless of socioeconomic status (SES), whereas registration in less prosperous areas depends largely on the racial, ethnic, and immigrant proportions in those areas. Moreover, the very highest SES neighborhoods in the study area (northern California minus greater Sacramento) have very high levels of donor registration despite high racial, ethnic, and national origin diversity.

Reduced effectiveness of standard recruitment for deceased organ donor registration: the need for population-specific recruitment materials.

BACKGROUND: The low rate of deceased donor organ donation limits the availability of life-saving transplants. Transplant candidate caregivers are an under-utilized but potentially devoted pool of advocates who themselves may be recruited to register for deceased organ donation. AIMS: To compare the effectiveness of recruitment materials in Transplant Candidate Caregivers (TCC) and San Francisco Bay Area Health Fair Attendees (HFA). METHODS: Each subject was given a California Transplant Donor Network educational pamphlet and cohort-coded registration materials. The primary outcome was the number of new registrations per recruitment packet distributed. RESULTS: A total of 232 recruitment packets were distributed; 116 to each of the two cohorts. The TCC group was more likely to be older (49 vs. 45, p = 0.05), female (71 vs. 63%, p = 0.2), Hispanic (21 vs. 5%, 0.001), married (75 vs. 33%, p < 0.0001), and less educated (p = 0.007). Despite demographic differences, the two groups had similar prior donor registration rates (40% TCC vs. 50% HFA, p = 0.11). However, with a minimum 2-week follow-up, the number of new registrations was only nine in the TCC cohort as compared to 38 in the HFA cohort (0.33 vs. 0.80 new registrations/packet, p < 0.0001). CONCLUSIONS: The effectiveness of standard deceased donor registration recruitment materials is reduced in Transplant Candidate Caregivers as compared to Health Fair Attendees. This reduced efficacy may be due to dissimilar demographics, psychosocial status at time of recruitment, and beliefs about organ donation. Development of audience specific recruitment materials may improve efforts to register Transplant Candidate Caregivers for deceased organ donation.