“SAYING YES – WHO ACTUALLY REGISTERS AS ORGAN AND … Paulson.pdfthrough their state donor registries. In North Carolina, a person may join the state donor registry at the Division

“SAYING YES – WHO ACTUALLY REGISTERS AS ORGAN AND EYE DONORS AT NORTH

CAROLINA’S DIVISION OF MOTOR VEHICLES (DMV) OFFICES?”

By

Katie Paulson

MPA Candidate 2013

A paper submitted to the faculty of

The University of North Carolina at Chapel Hill

in partial fulfillment of the requirements for the degree

Master of Public Administration

April 1, 2013

This paper represents work done by a UNC-Chapel Hill Master of Public Administration student. It is not

a formal report of the School of Government, nor is it the work of

School of Government faculty.

Executive Summary

Most organ and tissue donation literature focuses on the motivations, beliefs, and characteristics that

influence why people do or do not register as donors. This paper evaluates whether citizen demographics,

gathered from U.S. Census data, impact North Carolina’s DMV donor designation rates. Initial analysis

demonstrates that some demographic variables, such as certain races and ethnicities, do have statistically

significant relationships with individual DMV office donor designation rates. Surprisingly, DMV senior

examiners identified during interviews that the phrasing used by DMV examiners to ask customers

whether they would like to register as organ and eye donors had the most positive impact on their offices’

designation rates, which may lead to re-evaluation of how best to engage resources in order to increase

donor designation rates at DMV offices.

1

Problem

Currently, over 117,000 Americans, including 3,600 North Carolinians, are on the national transplant

waiting list. On average, 18 people will die each day because they did not receive a life-saving organ

transplanti. While certain organ donations can take place while people are living, such as donating one

kidney, the majority of organ donations occur after a person dies. The best method for increasing the

number of potential organ donors is to increase the number of individuals who register as organ donors

through their state donor registries. In North Carolina, a person may join the state donor registry at the

Division of Motor Vehicles (DMV) or online at DonateLifeNC.org. Over 99 percent of people register as

organ donors at the DMV during driver’s license issuances or renewals. This decision is legally binding

for those aged 18 and older.1 In 2010, approximately 52 percent of North Carolinians aged 16 and above

registered to be organ donors through NC DMV offices.ii

Donate Life North Carolina, a statewide nonprofit, works to inspire North Carolinians to register as organ,

tissue, and eye donors. The organization focuses on DMV and driver’s education programs; by

conducting outreach through existing structures that most North Carolinians use, Donate Life NC

maximizes its potential reach to ensure people have access to the resources to make informed decisions

about registering as organ donors. Outreach efforts include providing curriculum to driver’s education

instructors as mandated by state statutes and educating DMV examiners about the importance of asking

customers if they would like to register as organ donors.

Donate Life NC collects and analyzes designation rates for all 110 DMV offices in order to inform

community and educational outreach efforts, gauge marketing techniques, and react to media coverage.

Donate Life NC shares designation data regularly with its board of directors, funders, DMV leadership,

DMV examiners, volunteers, and the general public. In these discussions, three prevailing questions

emerge:

Why does this specific DMV office have the rate that it does?

What community factors may be influencing whether people elect to register or not?

To what extent do the demographics of the customer population impact the DMV’s donor

designation rates?

Prior to this research, Donate Life NC was not able to identify what, if any, community or demographic

variables impacted donor designation rates at individual DMV offices.

Literature Review

Literature on organ donation addresses reasons why people do and do not register as donors. Some studies

focus on sociological underpinnings for organ donation registration, including social networks, civic-

mindedness, empathy, and moral obligations.iii Other studies have evaluated the impact of modern myths

and misconceptions related to organ donation. This may include fear that medical personnel will not save

a registered organ donor’s life, concern over how the body will be treated during donation, and belief that

the donor’s family will shoulder the burden of donation costs.iv

Studies on racial disparities in designation rates show increased levels of medical mistrust among

African-Americans compared to other racial groups.v Some of the mistrust stems from perceived

disparities in organ transplant allocation; a lack of African-American donor designations may contribute

to this misperception (African-Americans make up 30 percent of transplant recipients but only 20 percent

of donors).vi A Florida study supported prior research that found minority, low-income, and/or less-

educated residents demonstrated lower donor designation rates at statistically significant levels.vii

1 For individuals under age 18 who register as an organ donor, the individuals’ legal next-of-kin has final authority

for donation.

2

Other research shows that strong religious affiliations have both positive and negative impacts on donor

designation rates,viii

and particular religious identities have statistically significant bearing on donor

designations. For example, in one study, Catholic respondents responded 2:1 in favor of organ donation,

at a statistically significant level.ix The Catholic Church does favor organ donation as an act of charity

and in support of the church’s pro-life mission.x However, other studies link a refusal to register as an

organ donor to religious beliefs, such as the importance of maintaining an intact body for the after-life.

There is insufficient evidence to clearly identify religion’s impact on overall donor designation rates.

Based on the prevailing literature, profiles of individuals most likely to register as organ donors emerge

based on self-identified characteristics such as age, gender, race, ethnicity, median income, and other

socioeconomic data. For instance, individuals most likely to register as organ donors identify as non-

Hispanic, Caucasian females, ages 18 to 49 from middle to upper income families. Additionally, research

connects higher education levelsxi and stronger Christian faiths

xii contribute to increased willingness to

register as organ donors.

Research Questions

When evaluating donor designation rates in NC DMV service areas, do community profiles

(social, economic, educational, and religious factors) explain the variation in organ donation

designation rates?

If so, do these profiles align with the typical donor designation profiles outlined in the literature

above?

Methodology

Previous research has used surveys and focus groups to study organ donation attitudes and behaviors of

different demographic groups. This information helped organizations develop community outreach

efforts, but the data had not been compared to actual donor designation rates or Census data to determine

if certain variables affected designation rates more significantly. I wanted to take the most common

characteristics from the literature and determine which specifically impacted North Carolina DMV donor

designation rates.

To gather detailed demographics of areas surrounding DMV offices, I evaluated data on two levels. First,

I collected county-level demographics (race, gender, language, ethnicity, and age), education levels (high

school diploma and Bachelor’s Degree), religious affiliations, party voting affiliation (most recent

Presidential election results) and socio-economic data (unemployment rate and poverty rate). (See Table

2.1, Appendix) I used these multiple variables to determine whether county donor designation rates and

its corresponding citizen populations paralleled the most likely donor designation profiles in the literature.

Second, I gathered 2010 US Census data on age, race, ethnicity, and gender for each DMV office service

area (community-level data). (See Table 2.2, Appendix) While county-level data provides a broad

overview of the interplay between specific variables and donor designation rates, certain counties house

more than one DMV office. Evaluating community-level variables allows for a closer identification of

trends and anomalies. Lastly, I conducted interviews with three DMV senior examiners to provide insight

on other factors that may impact individual office donor designation rates. All senior examiners, whose

offices each had above average designation rates, noted the organ donation question wording had a

connection to their offices’ higher than average donor designation rates.

Regression Analysis

I ran multiple linear regressions on both county and community demographic variables, starting with all

variables and then removed non-significant ones to isolate the most significant, regardless of whether the

variable had a positive or negative relationship with designation rates. My goal was to determine which

county-level and community-level variables had statistically significant relationships with 2010

3

individual DMV donor designation rates. Table 1.1 highlights statistically significant variables, the unit of

analysis, significance percentage, and the relationship each variable has on DMV donor designation rates

(positive or negative).

Table 1.1 Demographic Variables Tested and Their Relationship with Donor Designation Rates

Positive Relationship with Designation Rates Negative Relationship with Designation Rates

County: High School Graduates ** County: Economic: Unemployment Rate*

County & Community: Race: White** County: Language Other than English spoken at

home*

County: Ethnicity: Non-Hispanic** County & Community: Race: Black**

County: Age: Under 18* Community: Race: American-Indian/Alaskan

Native**

Community: Race: Other**

Community: Age Grouping: 65 and older**

County: Age Grouping: 55-59

County & Community: Ethnicity: Hispanic** *95% significance

**99% significance

The statistical significance of most variables in this model, specifically racial identity, education level

(high school diploma), and middle-aged populations, are consistent with the literature. The

unemployment rate is one indicator of low socioeconomic status, which according to the literature

contributes to lower designation rates. In this model, the unemployment rate variable was statistically

significant. Yet, the percent of people living under the poverty line in each county was not a statistically

significant variable on the designation rates. The significance of some age demographics demonstrates a

departure from the literature. The presence of a large 18-34 year old demographic for both county-level

and community-level did not demonstrate a statistically significant relationship with DMV designation

rates. It is difficult to discern whether the under 18 aged population has actual implications on the donor

designation rates. Teenagers ages 16 and 17 are more willing to register as organ donors compared to

older adult populations. However, data could not be broken down into specific groupings below age 18.

Interestingly, gender, Bachelor’s degrees, and religious affiliations were not statistically significant in this

model. The literature highlights a gender gap, with males more often refusing designation. Yet, neither

gender variable returned as statistically significant in the county-level or community-level models.

Religious affiliation may be more difficult to flesh out, as the literature presents religion as having both a

positive and a negative relationship with donor designation rates. Individuals cite religious beliefs as

motivations for altruistic deeds, such as organ donation. Similarly, individuals of the same creed support

the need for an intact body in order to continue into the afterlife, thus abstaining from organ donation

registration. The variables explained more within the county-level data regression model (almost 80

percent) than the community-level data model (almost 50 percent). Other community-level variables may

have been unaccounted for within the model. Therefore, I conducted interviews to further explore other

variables not captured in my regression analysis.

Interviews

After identifying statistically significant variables for North Carolina’s donor designation rates, I revisited

the individual DMV office data. I focused on DMV offices with higher than average donor designation

rates and above average population concentrations of the significant variables.xiii

Of all DMV offices, 17

offices had higher than state average donor designation rates despite having large populations shown to

impact donor designation rates negatively. Three striking examples are highlighted below:

4

Louisburg DMV: This office has continued to increase its rate over the last three years despite

over 50 percent of neighborhood population identifying as African-American, as well as a 65 and

older population comprising one-quarter of its demographics. Its designation rate in 2010 was

52.1 percent.

Manteo DMV: This office boasts one of the highest donor designation rates in North Carolina:

63.6 percent. However, its community is atypical of the expected registered organ donor: higher

than state average residents aged 65 and older as well as minority (African-American, American

Indian/Alaskan Native, and those identified as “other”) populations.

Mooresville DMV: Over the last five years, the Mooresville office, one of two offices in Iredell

County, maintained a donor designation rate well above the state average (62.8 percent in 2010).

This is unexpected as almost half of the office’s neighborhood residents identify as African-

American and Hispanic, two demographic variables that have a negative correlation with donor

designation rates.

I interviewed the three senior examiners for the Louisburg, Manteo, and Mooresville offices. Each senior

examiner was asked, “In your opinion, why does your DMV office have higher than average donor

designation rates?” My purpose was to determine whether the senior examiners believed practices of the

DMV office itself influenced its donor designation rates.

The senior examiners’ responses were mixed.

Senior Examiner Alston believes Louisburg’s high rates stem from his role as senior examiner: “I

listen to each exchange between my examiners and customers to be sure they are asking the

question each time. It has to come from the senior examiner to emphasize that culture for the

office.”

Senior Examiner Adkins in Manteo sees Manteo’s strong sense of community as a reason for the

office’s higher donor designation rates. “Everyone knows each other within the community.

People are always willing to help one another, such as holding a fundraiser for someone who was

just diagnosed with cancer.”

Senior Examiner Clark offered a different view from Mooresville, “I don’t believe we are doing

anything that impacts the customers’ decisions to register.” Instead, Senior Examiner Clark

believes other variables not included in the study contribute to the higher designation rates. “We

process applications for a lot of out-of-state residents, approximately 25 – 40 a day. These

individuals tend to agree to donate more often than those who have lived in the community for

years,” Clark shared.

Interestingly, all three examiners highlighted the importance of how the DMV examiner asks the

question. The DMV script calls for examiners to ask customers, “Are you an organ donor?” Yet, all three

senior examiners request their staff inquire by using the phrase: “Would you like to be an organ donor?”

Senior Examiner Alston specifically mentioned how he asks in polite, respectful tone, including language

such as “sir” and “ma’am.” Furthermore, all three senior examiners noted the importance of their own

education about organ donation as a factor that may influence customers’ decisions on registering. Senior

Examiner Adkins commented, “We are able to explain to customers that EMS won’t let you die if you are

an organ donor and other misconceptions.” Additionally, Senior Examiner Alston also referred to

addressing common myths, “I tell them they aren’t too old to donate since there is no age limit.”

There are similarities between the three different senior examiner perspectives. A senior examiner’s own

feelings towards organ donation may have a profound influence on whether customers’ register. These

feelings may manifest in the way the examiner reads the question, what tone the examiner uses when

5

asking the question, and whether the examiner addresses customers’ questions or concerns about

registering. Yet, other variables may be impacting rates, such as increases in out-of-state populations and

presence of community support systems.

Research Limitations

One challenge in data collection was the presence of multiple DMV offices in one county. The county

donor designation rates used represented an average for those areas with more than one driver’s license

office. Focusing on neighborhoods surrounding the individual DMV offices was intended to counteract

the generalizations made through county-level data. However, it is possible the community surrounding

the office may not be an accurate reflection of populations who use the office. Moreover, the model does

not take into account DMV data, such as customer wait time, staff turnover rates, examiners’ personal

beliefs about organ donation, and examiner demographics, which all have potential influences on how

customers respond to “Are you an organ donor?” Finally, by evaluating only one year, I am not capturing

any trends, such as population shifts.

Next Steps

I did not intend to produce a research model template that could increase the number of donor

designations. Instead, this study provided a quantitative foundation to use as part of strategic community

outreach conversations. Similar to other health and human service efforts, organ, tissue, and eye donation

organizations adjust their outreach models based on evidence-based practices. Instead of working in

isolation, more agencies with similar interests in increasing the number of organs available for transplant

are evaluating other key stakeholders to tackle the complex public image of organ, tissue, and eye

donation.

Using the three DMV offices identified in this paper, I advise Donate Life NC to delve deeper into those

communities by partnering with community organizations and local leaders to share information and

create new hypothesis together on what other influences may be impacting those offices’ donor

designation rates. Based on the research model, part of the designation rates can be explained through

traditional demographic variables. However, there is still much more to be captured through deeper

analysis and more focused attention to community dynamics. I would also explore the relationship

between variables within the regression models. This information could provide additional context for

community outreach opportunities or collaborative partnerships. For instance, we may find individuals

identified as African-American and female are significantly more likely to be registered donors.

Therefore, we would reach out to organizations working with this specific demographic.

Conclusion

Overall, the research corroborated and contradicted different elements of current organ donation

literature. Certain demographic variables (race, ethnicity, and certain age demographics) do have a

statistically significant relationship with NC DMV donor designation rates. However, other characteristics

implicated in the literature (gender, religious affiliation, and younger age demographics) did not

demonstrate a similar relationship. By applying the findings to individual DMV offices, I identified 17

offices with above average donor designation rates compared to expected rates based on surrounding

population data. This led to the question: Why do these offices have these donor designation rates? Senior

examiners from three offices offered their perspectives, which included the influence of office personnel,

non-local residents, and community support. Most importantly, the examiners brought attention to the

phrasing used to ask customers if they would like to register as an organ and eye donor and how asking in

a particular way likely garners more positive responses. These explanations should be explored further

with other DMV offices in order to better inform community education and outreach on the importance of

registering as an organ donor.

6

References

Arrioloa, Kimberly Jacob; Jennie Perryman, and Michelle Doldren. “Moving Beyond Attitudinal

Barriers: Understanding African Americans’ Support for Organ and Tissue Donation.” Journal

of the National Medical Association. Vol. 97, No. 3. March 2005. 339 – 350.

Bekkers, Rene. “Traditional and Health-Related Philanthropy: The Role of Resources and Personality.”

Social Psychology Quarterly. Volume 69, Number 4. 2006. Accessed August 2012. 349-366.

Bouldware, Ebony; Lloyd Ratner; Lisa Cooper; Julie Ann Sosa; Thomas Laveist, and Neil Powe.

“Understanding Disparities in Donor Behavior: Race and Gender Differences in Willingness to

Donate Blood and Cadaveric Organs.” Medical Care. Volume 40, Number 2. 2002. 85-95.

Brug, Johannes; Mark Van Vugt; Bart van Den Borne; Andre Brouwers; and Hans Van Hoof. “Predictors

of Willingness to Register as an Organ Donor Among Dutch Adolescents.” Psychology and

Health. Volume 15, December 2000. 357-368.

Kurz, Richard; Darcell Scharff; Terry Tanchica; Shanica Alexander, and Amy Waterman. “Factors

Influencing Organ Donation Decisions by African Americans.” Medical Care Research and

Review. Volume 64, Number 5. October 2007. Accessed July 2012. 475 – 517.

Morgan, Susan; Tyler Harrison; Walid Afifi; Shawn Long, and Michael Stephenson. “In Their Own

Words: The Reasons Why People Will (Not) Sign an Organ Donor Card.” Health

Communication. 2008. Accessed September 2012. 23-33.

Morgan, Susan; Lauren Movius, and Michael Cody. “The Power of Narratives: The Effect of

Entertainment Television Organ Donation Storylines on the Attitudes, Knowledge, and Behaviors

of Donors and Nondonors.” Journal of Communication. 2009. 135-151.

Rodrigue, James; Jennifer Krouse; Christopher Carroll; Kathleen Giery; Yilian Fraga, and Elizabeth

Edwards. “A Department of Motor Vehicles Intervention Yields Moderate Increases in Donor

Designation Rates.” Progress in Transplantation, Volume 22, No 1. March 2012. 18 – 24.

Rodrigue, James; Cornell, Danielle; and Howard, Richard. “Pediatric Organ Donation: What Factors

Most Influence Parents’ Donation Decisions?”. Pediatric Critical Care Med. March 2008. 180 –

185.

Siminoff, Laura; Christopher Burant, Sald and Ibrahim. “Racial Disparities in Preferences and

Perceptions Regarding Organ Donation.” Populations at Risk. 2006. Accessed September 2012.

995 – 1000.

7

Acknowledgements

I want to extend my deepest appreciation to my committee members: Margaret Henderson, Gregory

Allison, and Kelley O’Brien for providing thoughtful feedback and guidance throughout this process.

Second. I want to thank the Donate Life North Carolina staff and board of directors for allowing me to

use data and resources for the project.

Finally, I am thankful to the Division of Motor Vehicle (DMV) staff, especially the senior examiners,

whose assistance cast unforeseen insight to the initial research questions.

8

Appendix

Definitions

Actionable Donor Designation (ADD)= when an individual agrees to be a registered organ and eye donor

at the DMV and a red heart is placed on his/her driver’s license or Identification Card

ADD Share is the percentage of all licensed drivers and ID card holders who have an Actionable Donor

Designation (a heart symbol) on their license or ID card.

ADD Rate is the rate at which driver and ID card applicants choose to renew or add an Actionable Donor

Designation to their license or ID card within a given time period.

Next Steps

Some other questions to explore with community leaders may include:

What affinity groups may be present in these communities?

How does educational outreach for other issues function?

What role do media outlets (traditional and non-traditional) play in these communities?

What role does storytelling have?

How is death perceived in the communities?

What is the perception of medical institutions within community?

How does the community come together to support its members and residents?

9

Table 2.1 County Level Variables Tested

Demographic Variable Data Point(s) Source

Educational Attainment High School Diplomas Earned,

Bachelor’s Degrees Earned,

U.S. Census Bureau –

www.census.gov

Racial Identification White, Black, Asian U.S. Census Bureau –

www.census.gov

Age Demographic Groupings: Under 18, 18-24, 25-

34; 35-39; 40-44; 45-49; 50-54;

55-59; 60-64; 65+


www.census.gov

Economic Indicator 2010 Unemployment Rate

(Average), Population Living

Below Poverty


www.census.gov

Political Indicator Did the Democratic party receive

the majority of votes in 2012

Presidential Election?

North Carolina Board of

Elections

Religious Affiliation Percent of population identified

as having religious affiliation

Jones, Dale E., et al. 2002.

Congregations and Membership

in the United States 2000.

Nashville, TN: Glenmary

Research Center.

Social Affiliation Percent of population speaking

language other than English at

home


www.census.gov

Table 2.2 Community Level Variables Tested

Variable Data Extracted Source

Racial Identification White, Black, Asian, Multi-

racial, Other, American

Indian/Native American

U.S. Census Bureau – Interactive

Maps

Age Demographics Groupings: Under 18, 18-24, 25-

34; 35-39; 40-44; 45-49; 50-54;

55-59; 60-64; 65+

U.S. Census Bureau – Interactive

Maps

Table 3.1 County-Level Data Regressions

Model Summary

Model R R Square Adjusted R Square Std. Error of the

Estimate

1 .905(a) .819 .771 3.9018%

(a) Coefficients

Model Unstandardized

Coefficient

Standardized

Coefficients

T Sig

B Std. Error Beta

(Constant) 65.139 22.461 2.900 .005

Protestant .088 .049 .116 1.793 .078

Orthodox 2.763 3.055 .068 .904 .369

NonEnglishAtHome -.424 .229 -.197 -1.848 .069

UnemploymentRate -.668 .375 -.164 -1.783 .080

10

Did Democratic Party Receive

Majority of Votes in

Presidential 2012 Election?

-.652 1.613 -.037 -.404 .688

Under18 -.287 .160 -.133 -1.799 .077

25-34 -.459 .537 -.105 -.855 .396

45-54 -.896 .647 -.127 -1.383 .171

55-59 -1.486 .962 -.152 -1.544 .128

65+ -.357 .194 -.183 -1.836 .071

American Indian -.131 .124 -.088 -1.061 .293

Asian .294 .707 .046 .416 .679

Black -.317 .052 -.576 -6.103 .000

2 or more Races .616 1.269 .052 .486 .629

HighSchoolGrads .504 .247 .330 2.039 .046

BachDegree -.045 .161 -.049 -2.77 .783

PopulationBelowPovery -.114 .166 -.064 -.687 .495

Model Summary


Estimate

2 .899(a) .808 .784 3.7837%

(a) Coefficients


Coefficient

Standardized

Coefficients

T Sig

B Std. Error Beta

(Constant) 40.505 13.570 2.985 .004

Protestant .068 .045 .090 1.500 .138

NonEnglishAtHome .343 .157 -.159 -2.183 .032


Under18 -2.77 .129 -.128 -2.142 .036

55-59 -2.237 .678 -.229 -3.298 .002

65+ -.224 .153 -.115 -1.457 .149

AmericanIndian -.125 .084 -.084 -1.487 .141

Black -.339 .033 -.616 -10.195 .000


Model Summary


Estimate

3 .859(a) .738 .721 4.3061%

(a) Coefficients


Coefficient

Standardized

Coefficients

T Sig

B Std. Error Beta

1 (Constant) 3.254 13.417 .243 .809

NonEnglishAtHome -.310 .156 -.144 -1.990 .050

55-59 -2.741 .694 -.281 -3.949 .000


11


White .268 .031 .542 8.523 .000

Table 3.2 Community-Level Data Regressions

Model Summary


Estimate

1 .734a .538 .476 5.7813%

(a) Coefficients


Coefficient

Standardized

Coefficients

T Sig

B Std. Error Beta

(Constant) 38.854 15.484 2.509 .014

Female .249 .180 .143 1.385 .169

Under 18 .063 .172 .044 .365 .716

Age 20-24 .248 .217 .177 1.142 .256

Age 35-49 .094 .244 .031 .387 .700

Age 50-64 .208 .207 .113 1.008 .316

Age 65+ -.277 .102 -.314 -2.718 .008

African-American -.205 .029 -.566 -7.031 .000

Asian -.080 .243 -.027 -.328 .743

American Indian/Alaskan

Native

-.327 .081 -.307 -4.026 .000

Native Hawaiian/Pacific

Islander

2.465 4.784 .038 .515 .608

Other Race -1.206 .365 -.932 -3.303 .001

2 or more Races -.194 .164 -.105 -1.185 .239

Hispanic .798 .244 1.024 3.265 .002

Model Summary


Estimate

2 .721a .520 .497 5.6651%

(a) Coefficients


Coefficient

Standardized

Coefficients

T Sig

B Std. Error Beta

(Constant) 60.878 1.631 37.329 .000

65+ -.284 .062 -.322 -4.583 .000

African-American/Black -.195 .025 -.539 -7.844 .000

American Indian/Alaskan

Native

-.324 .073 -.304 -4.436 .000

Other (race) -.969 .300 -.749 -3.233 .002

Hispanic .597 .182 .765 3.272 .001

12

Model Summary


Estimate

3 .671a .451 .435 6.0020%

(a) Coefficients


Coefficient

Standardized

Coefficients

T Sig

B Std. Error Beta

(Constant) 57.240 5.136 11.144 .000

65+ -.339 .066 -.384 -5.116 .000

NonHispanic -.149 .059 -.188 -2.513 .013

White .208 .025 .606 8.174 .000

i Donate Life America website. http://www.donatelife.net. Accessed February 2012.

ii Donate Life NC Annual Report. April 2011.

iii Rene Bekkers. “Traditional and Health-Related Philanthropy: The Roles of Resources and Personality.” Social

Psychology Quarterly. Vol. 69, No. 4. 2006. 357. iv Brug, Johannes; Mark Van Vugt; Bart van Den Borne; Andre Brouwers; and Hans Van Hoof. “Predictors of

Willingness to Register as an Organ Donor Among Dutch Adolescents.” Psychology and Health. Volume 15,

December 2000. 358. v Kimberly R. Jacob Arriola, MPH; Jennie P. Perrmany, RN, PhD; & Michelle Doldren, MPH, CHES. “Moving

beyond Attitudinal Barriers: Understanding African Americans’ Support for Organ and Tissue Donation.” Journal

of the National Medical Association. Vol 97, No. 3, March 2005. 339. vi Richard S. Kurz, Darcell P. Scharff, Tanchica Terry, Shanica Alexander & Amy Waterman. “Factors Influencing

Organ Donation Decisions by African Americans.” Medical Care Research and Review. Volume 64, No. 5.

October 2007. 476. vii

James R. Rodrigue, PhD, Jennifer Krouse, BS, Christopher Carroll, APR, CPRC, Kathleen M. Giery, APR,

CPRC, Yillian Fraga, MSW; Elizabeth Edwards, BS. “A Department of Motor Vehicles Intervention Yields

Moderate Increases in Donor Designation Rates.” Progress in Transplantation, Vol. 22. No. 1. March 2012. 18. viii

Morgan, et all. 96. ix

Rios, Conesa, Ramirez et all. x UNOS website. http://www.unos.org/donation/index.php?topic=fact_sheet_9

xi L. Ebony Boulware, MD, MPH; Lloyd E. Ratner, MD; Lisa A. Cooper, MD, MPH; Julie Ann Sosa, MD; Thomas

A. LaVeist, MA, PhD, MPH, and Neil R Power, MD, MPH, MBA. “Understanding Disparities in Donor Behavior:

Race and Gender Differences in Willingness to Donate Blood and Cadaveric Organs.” Medical Care. Vol. 40, No.

2. 85. xii

Susan E. Morgan, Tyler R. Harrison, Walid D. Afifi, Shawn D. Long, Michael T. Stephenson. “In Their Own

Words: The Reasons Why People Will (Not) Sign an Organ Donor Card.” Health Communication, 23: 23 – 33,

2008. 30 xiii

Compared using statewide averages from U.S. Census Bureau 2010 data.

Documents

“SAYING YES – WHO ACTUALLY REGISTERS AS ORGAN AND … Paulson.pdfthrough their state donor registries. In North Carolina, a person may join the state donor registry at the Division