Original Article
Factors Perceived to Influence the Decision for African Americans to Become Registered Organ Donors at the Department of Motorized Vehicles

https://doi.org/10.1016/j.jnma.2017.04.004Get rights and content

Abstract

Background

African Americans (AA) are a third as likely as Caucasians to become registered organ donors at the Department of Motorized Vehicles (DMV). The Department of Health and Human Services has set the goal that at least 50% of adults in each state are registered donors.

Aims

The purpose of this study was to explore the personal, behavioral and environmental factors associated with AA donor registration decision-making at the DMV.

Methods

Guided by the Social Cognitive Theory, 13 focus groups (n = 100 participants) were conducted with AAs within 3 months of visiting a DMV and making a decision regarding whether to become or to not become a registered donor. The data were analyzed using inductive thematic and qualitative content analyses.

Results

Study participants expressed a desire to learn more information while waiting in line at the DMV. Knowing a family member or friend in need of an organ transplant, and the desire to make one's own decision were two salient factors associated with the decision to become a registered organ donor. Several aspects of the DMV environment (e.g., noisy, overcrowded, lacking privacy) were cited as deterrents to becoming a registered donor.

Discussion

This study highlights the personal, behavioral and environmental factors associated with AA organ donor registration decision-making at the DMV.

Conclusion

The DMV is a setting where many adults make a decision about organ donation. Policies that create an environment in the DMV to support informed decision-making (e.g., privacy, informed clerks, available educational materials, etc.) are indicated.

Introduction

There are 122,000 persons waiting for donor organs in the US as of 2015, but only around 30,000 transplants are performed each year.1 Examination of nationally available data demonstrates a large racial disparity in organ donation.2 For example, Caucasians are 4.7 fold more likely than African Americans to consent to organ donation according to a recent study of potential donors in Alabama.3 The disparity in organ donation is a significant public health challenge. In addition to being under represented in the donor pool, African Americans are significantly over represented on the transplant waitlist. In Alabama, for example, African Americans make up 26.7% of the population,4 yet comprise 67.6% of the renal transplant waiting list at the University of Alabama at Birmingham (UAB).2 Furthermore, in Alabama, 77% of Caucasians are registered organ donors, but only 28% of African Americans are registered organ donors.5 With the Department of Health and Human Services mandating that all states have a donor registry and set the goal that at least 50% of adults in each state are registered organ donors, these racial disparities highlight the need for interventions to increase African American organ donor registration.

Although rarely utilized for public health interventions, the ideal setting for these intervention programs may be the Department of Motor Vehicles (DMV). Most organ donor registrations (for all races) occur at the DMV.6 However, we know little about the decision making process about donation among adults visiting the DMV. The purpose this study was to begin to address the knowledge gap in the literature regarding the decision-making process of becoming a registered organ donor at the DMV.

Guided by Social Cognitive Theory,7, 8, 9 this qualitative study identified the personal, behavioral, and environmental factors that influence motivation and result in a decision to become or to not become a registered organ donor among African American adults who visited the Alabama DMV. Two groups were compared: African Americans who made a first time decision to become a registered organ donor and African Americans who chose not to register as an organ donor.

Section snippets

Participant recruitment

The study protocol obtained institutional review board approval. Study participants were African American women and men 19 years or older who visited an Alabama Driver's License office and made a decision (yes or no) to become a registered organ donor. A list of potential participants was provided by the Alabama Department of Public Safety on a quarterly basis. Participants were contacted and scheduled to complete the study protocol within 3 months of visiting the DMV. A postcard was mailed to

Theoretical framework

Focus group questions were organized around the constructs of the Social Cognitive Theory that provided a framework for exploring factors that may be associated with the choice to become a registered organ donor. The Social Cognitive Theory argues that human behavior is shaped by personal, behavioral, and environmental influences, and that the three (behavior, person, and environment) function in a reciprocally determinant manner.7 This means that behavior can both shape and be shaped by the

Results

Through the exploration of the views and experiences of participants who became registered donors and those that did not, several themes emerged that provide a deeper understanding of the intra- and interpersonal factors important for African American organ donor registration at the DMV. The description of the themes are organized consistent with the central paradigm of the Social Cognitive Theory that posits that behavior is a function of both the person and the environment and that the three

Discussion

Understanding the personal, behavioral, and environmental factors that influence decision-making at the DMV is important for designing interventions to increase African American organ donor registration. This study is unique because the research protocol was conducted with African American adults within 3 months of visiting the DMV and making a decision regarding becoming a registered organ donor. The dominant factor that was associated with the decision for participants to become a registered

Acknowledgements

Research was supported in part by a Charles Barkley Health Disparities Research Award (D. DuBay) and NIH NIDDK 1 K23 DK091514 (D. DuBay) and 1 R03 DK106432 (D. DuBay).

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  • Cited by (10)

    • Primary care interventions to encourage organ donation registration: A systematic review

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      A strong body of evidence supports the use of active methods of recruitment to organ donation registers in other settings, specifically the Driving Motor Vehicles (DMV) offices in the USA. Numerous studies have investigated how to improve sign-up rates in this setting, the majority of which have found success [40–53]. The generalisability of these studies internationally however, is challenging, due to the unique nature of the DMV to the USA.

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    Disclosures: The authors declare there are no conflicts of interest.

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