By 1997, the Delaware Valley Transplant Program (DVTP) in Philadelphia knew it was close to cracking the code on a national collaborative solution to boost organ donation, when it helped draft Pennsylvania Act 102 in 1994.
This state legislation, commonly referred to as "routine referral," requires all area hospitals to contact DVTP whenever a death occurs to determine whether the deceased is a potential donor. Within the same three-year timeframe, New Jersey and Delaware adopted similar laws and the mid-Atlantic region experienced a record 40 percent boost in organ donation and a 49 percent increase in transplants performed. Nationally, the organ donations for the same period increased a meager 6 percent.
DVTP's experience prompted the national press and the federal government to take notice, ultimately redirecting the national legislative focus from organ allocation to organ donation, says Howard Nathan, DVTP's executive director. Last year, the U.S. Department of Health and Human Services (DHHS) implemented new Medicare requirements modeled after the DVTP program. Now all U.S. hospitals seeking Medicare reimbursement must contact their local organ procurement organization (OPO) when a death occurs. DHHS anticipates routine referral will increase national organ donation by 20 percent in two years.
Model Components
The main reason the DVTP program succeeded so quickly is due to the rock-solid trust established with area hospitals and physicians through its educational outreach arm, says Nathan. "We had to show hospitals that all they have to do is pick up the phone and that we're capable of taking care of the rest."
The program's early success then provided compelling media hooks for the national press, casting a positive light on the overall organ donation/transplant industry which is often mired in controversy.
To convince area hospitals and healthcare professionals to buy into the program, DVTP made them aware that its trained coordinators were experts in dealing with grieving families on the sensitive issue of organ donation. DVTP also focused on the large number of missed opportunities for organ donation when hospital employees are too uncomfortable to discuss organ donation or don't know which patients would make good donors. The donation criteria changes constantly.
The new rules make it easier for hospitals to focus on their primary duty - to save lives - and not deal with the awkward discussion of organ donation when lives are lost. That's not how the American Hospital Association first viewed the rules, however. The AHA initially opposed the federal rules, believing individual hospitals should retain control over the way organ donations are discussed within their facilities.
But the AHA eventually backed off largely due to the 40 percent increase in donations the DVTP program achieved and the success of other states that adopted the program, says Nathan.
The DVTP initiative also helped turn the national spotlight away from the controversial organ allocation debate to efforts that increase donation.
An estimated 12,000 to 15,000 people die each year from whom organs could be harvested, but fewer than 5,500 became donors in 1997. "We've always argued that getting more organs is the real issue-not allocation," says Nathan who used to head the Coalition on Donation (COD), a national network of coalitions.
DVTP pitched the national press about its record-breaking success, arming reporters with compelling market research and the program's national application. Mainstream media outlets like USA Today, Associated Press and the Philadelphia Inquirer got the message, running in-depth stories about how the "model program" is boosting organ donation. The press coverage also helped make DVTP's argument that organ donation efforts are where the real solutions exist and not how organs are allocated.
Ad Campaign Changes Perceptions
If DVTP's program successfully educated hospitals about how to increase organ donations, COD's campaign, "Share Your Life...Share Your Decision," provided the right public awareness backdrop for informing the nation about why families need to discuss their intentions. The campaign, launched in 1994 with Michael Jordan as one of its high-profile spokespersons, has greatly improved the public's perception of organ donation, says Melissa Devenny, COD's senior communications coordinator.
The bottom line is developing donor readiness so that when OPO coordinators approach a grieving family member about organ donation, that person already has positive feelings about organ donation. In this way, the legislative and advertising efforts worked well together, says Kevin Sparkman, DVTP's community relations manager.
Overall, the media has been a willing messenger, donating the equivalent of $112 million in advertising time and space for the public service announcements as of 1997, according to Devenny.
There is still much work to be done in getting individuals to discuss their organ donation requests with family members. Most people think that signing a donor card automatically makes them a donor; very few understand the importance of sharing this decision with their family.
(DVTP, Howard Nathan, Kevin Sparkman, 215/557-8090; COD, Melissa Devenny, 804/330-8637)