Organ donor availability limits organ transplantation. Strategies are needed to increase organ donation, especially among minority populations.1 Altruism motivates blood and organ donors. Thus, blood donors might be potential targets to increase organ donation.
We assessed organ donor registration rates of high school students, comparing blood donors with non–blood donors. In California, anyone age 17 years or older can donate blood, and those 13 years or older can register as organ donors.
This study was conducted in 4 high schools from geographically and socioeconomically distinct areas in California with diverse racial/ethnic student populations. Participating students completed a questionnaire administered by student surveyors trained by 2 science teachers (B.H. and M.T.) and a university professor (A.K.) (eAppendix in the Supplement). Student surveyors were instructed to approach students randomly; of those approached, approximately 80% of students agreed to participate. This cross-sectional study was approved by the University of California, San Diego, institutional review board. No personally identifiable data were collected, so informed consent was waived.
Analyses were performed using the Fisher exact test and multivariate logistic regression, and reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cross-sectional studies. The threshold for statistical significance was set at 2-sided P = .05. More information about the methods used in the study is provided in the eAppendix in the Supplement.
We surveyed 1784 students: 814 (45.6%) male students, 784 (43.9%) Hispanic, 482 (27.0%) White, 180 (10.1%) African American, 151 (8.5%) multiracial, 142 (8.0%) Asian, and 17 (1.0%) American Indian (Table 1). Among 953 blood donors, 314 students (32.9%) were registered as organ donors, compared with 198 of 831 non–blood donors (23.8%) (P < .001) (Table 1). Significance was maintained when analyzed by sex: 144 male (35.1%) and 170 female (31.3%) blood donors were registered as organ donors, compared with 95 male (23.5%) and 103 female (24.1%) non–blood donors (P < .001 for male students, and P = .01 for female students) (Table 1). When analyzed by race/ethnicity, more White blood donors were registered as organ donors than White non–blood donors (118 blood donors [47.2%] vs 58 non–blood donors [25.0%]; P < .001) (Table 1). There were no other statistically significant differences by race/ethnicity.
Among students not already registered as organ donors, more than half were willing to register as organ donors, 367 blood donors (57.4%) and 332 non–blood donors (52.5%) (Table 1). There was no statistically significant difference between blood donors and non–blood donors, but more female blood donors were willing to register as organ donors than female non–blood donors (252 blood donors [67.6%] vs 174 non–blood donors [53.7%]; P < .001); there was no difference for male students. Comparing by sex, more female blood donors were willing to register as organ donors than male blood donors (252 female students [67.6%] vs 115 male students [43.2%]; P < .001); no difference existed between male and female non–blood donors. Among racial/ethnic groups, more White blood donors were willing to register as organ donors than White non–blood donors (82 blood donors [62.1%] vs 81 non–blood donors [46.6%]; P = .008). This was not true for other racial/ethnic groups (eg, non-White Hispanic: 185 blood donors [56.2%] vs 144 non–blood donors [56.7%]; P = .93).
Multivariable regressions qualitatively affirmed these findings (Table 2). Blood donors were significantly more likely to be registered organ donors (odds ratio [OR], 1.60; 95% CI, 1.29-1.97; P < .001). Interactions of blood donor status with organ donor registration were significant for race/ethnicity (eg, White race: OR, 2.12; 95% CI, 1.34-3.36; P < .001), and sex (eg, organ donation willingness for male blood donors: OR, 0.40; 95% CI, 0.26-0.64). This supported stratified analyses, which corroborated the finding that blood donation was associated with organ donor registration in White students (OR, 2.73; 95% CI, 1.85-4.04; P < .001), and to organ donation willingness in female students (OR, 1.79; 95% CI, 1.32-2.44; P < .001).
This cross-sectional study found that high school student blood donors were registered as organ donors at higher rates than non–blood donors. White blood donors were more likely to be willing to register as organ donors than White non–blood donors, and there were no other statistically significant differences by race/ethnicity. Among those not registered as organ donors, female blood donors were more likely to be willing to register than non–blood donors.
If expressed willingness to register as an organ donor translates to registration, then simply asking high school students to register as organ donors might increase registration. However, intent does not always translate to action.2,3
This study had limitations. First, students self-reported registration and willingness to register as organ donors; prosocial behaviors can be overreported.4,5 Second, the questionnaire was purposefully short to prevent survey exhaustion, which precluded assessing factors that may motivate or deter organ donor registration. Third, most blood donors were surveyed immediately after donating blood, an altruistic activity, which could have led to overreporting of willingness to be organ donors.
Accepted for Publication: June 25, 2020.
Published: September 18, 2020. doi:10.1001/jamanetworkopen.2020.16377
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Tat J et al. JAMA Network Open.
Corresponding Author: Gerry R. Boss, MD, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093 (gboss@health.ucsd.edu).
Author Contributions: Drs Tat and Boss had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Hays, Teachworth, Pilz, Boss.
Acquisition, analysis, or interpretation of data: Tat, Hays, Teachworth, Kuo, Golomb, Boss.
Drafting of the manuscript: Tat, Boss.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Tat, Golomb.
Obtained funding: Boss.
Administrative, technical, or material support: Hays, Teachworth, Boss.
Supervision: Hays, Teachworth, Boss.
Conflict of Interest Disclosures: Dr Golomb reported receiving funding from the US Department of Defense outside the submitted work. Dr Boss reported grants from National Institutes of Health during the conduct of the study. No other disclosures were reported.
Funding/Support: This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant No. R01DK098780 to Dr Boss and partial support by the National Institute of General Medical Sciences Institutional Research and Academic Career Development Awards K12 grant No. GM068524 to Dr Tat.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Adriano Chan, BSc, University of California, San Diego, collated and organized the data; Eero Dinkeloo, MPH, University of California, San Diego, helped to analyze the data. Both are employees of the university and did not receive extra compensation for their contribution to the study.