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Effect of an iPod Video Intervention on Consent to Donate Organs: A Randomized Trial

J. Daryl Thornton, MD, MPH; Marilyn Alejandro-Rodriguez; Janeen B. León, MS, RD, LD; Jeffrey M. Albert, PhD; Evelyn L. Baldeon; Liza M. De Jesus, BA; Ana Gallardo; Sabina Hossain; Elba Adriana Perez; Jovana Y. Martin, MD; Susan Lasalvia, RN, BSN; Kristine A. Wong, MJ, MPH; Margaret D. Allen, MD, DrSC(Hon); Mark Robinson, MA; Charles Heald; Gordon Bowen, MS; and Ashwini R. Sehgal, MD
[+] Article, Author, and Disclosure Information

Disclaimer: Drs. Thornton and Albert 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. All persons who contributed substantially to this work were included in the author list.

Grant Support: By the National Institute on Minority Health and Health Disparities (grant 1-P60MD002265-01), National Center for Research Resources (grant UL1RR024989), and Robert Wood Johnson Harold Amos Medical Faculty Development Program.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0571.

Reproducible Research Statement:Statistical code: Available from Dr. Thornton (e-mail, mailto:daryl.thornton@case.edu). Study protocol and data set: Not available.

Requests for Single Reprints: J. Daryl Thornton, MD, MPH, Center for Reducing Health Disparities, MetroHealth Medial Center, 2500 MetroHealth Drive, Rammelkamp R209A, Cleveland, OH 44109; e-mail, mailto:daryl.thornton@case.edu.

Current Author Addresses: Dr. Thornton, Ms. De Jesus, Ms. Perez, Ms. Lasalvia, and Mr. Robinson: 2500 MetroHealth Drive, Rammelkamp R209A, Cleveland, OH 44109.

Ms. Alejandro-Rodriguez: 2500 MetroHealth Drive, Rammelkamp R208A, Cleveland, OH 44109.

Ms. León: 2500 MetroHealth Drive, Rammelkamp R206A, Cleveland, OH 44109.

Dr. Albert: 10900 Euclid Avenue, WG-43, Cleveland, OH 44106-4945.

Ms. Baldeon: 307 Sanford Street, Painesville, OH 44077.

Ms. Gallardo: 4950 West 220th Street, Fairview Park, OH 44126.

Ms. Hossain: 268 Willow Street, New Haven, CT 06511.

Dr. Martin: 176F, Room 5329, 619 19th Street South, Birmingham, AL 35233.

Ms. Wong: PO Box 401, Half Moon Bay, CA 94019.

Dr. Allen: 1201 Ninth Avenue, Seattle, WA 98101-2795.

Mr. Heald and Mr. Bowen: 4775 Richmond Road, Cleveland, OH 44128-5919.

Dr. Sehgal: 2500 MetroHealth Drive, Rammelkamp R212A, Cleveland, OH 44109.

Author Contributions: Conception and design: J. Thornton, J. León, J. Albert, J. Martin, M. Allen, A. Sehgal.

Analysis and interpretation of the data: J. Thornton, M. Alejandro-Rodriguez, J. Albert, L. De Jesus, C. Heald, A. Sehgal.

Drafting of the article: J. Thornton.

Critical revision of the article for important intellectual content: J. Thornton, J. Martin, G. Bowen, A. Sehgal.

Final approval of the article: J. Thornton, J. Martin, C. Heald, G. Bowen, A. Sehgal.

Provision of study materials or patients: J. Thornton, M. Alejandro-Rodriguez, J. Martin, K. Wong, M. Allen.

Statistical expertise: J. Thornton, J. Albert, C. Heald, A. Sehgal.

Obtaining of funding: J. Thornton, J. León, M. Allen, A. Sehgal.

Administrative, technical, or logistic support: J. Thornton, M. Alejandro-Rodriguez, J. León, L. De Jesus, S. Hossain, J. Martin, M. Robinson, G. Bowen, A. Sehgal.

Collection and assembly of data: J. Thornton, M. Alejandro-Rodriguez, E. Baldeon, L. De Jesus, A. Gallardo, S. Hossain, E. Perz, J. Martin, S. Lasalvia

Figure. No caption available.

Grahic Jump Location

From the Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Case Western Reserve University, Cleveland Minority Organ Tissue Transplant Education Program, and Lifebanc, Cleveland, Ohio; University of Alabama at Birmingham, Birmingham, Alabama; University of California at Berkeley, Berkeley, California; and Benaroya Research Institute, Seattle, Washington.

Ann Intern Med. 2012;156(7):483-490. doi:10.7326/0003-4819-156-7-201204030-00004
Text Size: A A A

Background: The gap between the supply of organs available for transplantation and demand is growing, especially among ethnic groups.

Objective: To evaluate the effect of a video designed to address concerns of ethnic groups about organ donation.

Design: Cluster randomized, controlled trial. Randomization was performed by using a random-number table with centralized allocation concealment. Participants and investigators assessing outcomes were not blinded to group assignment. (ClinicalTrials.gov registration number: NCT00870506)

Setting: Twelve branches of the Ohio Bureau of Motor Vehicles in northeastern Ohio.

Participants: 952 participants aged 15 to 66 years.

Intervention: Video (intervention; n = 443) or usual Bureau of Motor Vehicles license practices (control; n = 509).

Measurements: The primary outcome was the proportion of participants who provided consent for organ donation on a newly acquired driver's license, learner's permit, or state identification card. Secondary outcomes included willingness to make a living kidney donation to a family member in need and personal beliefs about donation.

Results: More participants who viewed the video consented to donate organs than control participants (84% vs. 72%; difference, 12 percentage points [95% CI, 6 to 17 percentage points]). The video was effective among black participants (76% vs. 54%; difference, 22 percentage points [CI, 9 to 35 percentage points]) and white participants (88% vs. 77%; difference, 11 percentage points [CI, 5 to 15 percentage points]). At the end of the trial, fewer intervention than control participants reported having insufficient information about organ donation (34% vs. 44%; difference, −10 percentage points [CI, −16 to −4 percentage points]), wanting to be buried with all of their organs (14% vs. 25%; difference, −11 percentage points [CI, −16 to −6 percentage points]), and having conflicts with organ donation (7% vs. 11%; difference, −4 percentage points [CI, −8 to −2 percentage points]).

Limitation: How the observed increases in consent to donate organs might translate into a greater organ supply in the region is unclear.

Conclusion: Exposure to a brief video addressing concerns that ethnic groups have about organ donation just before obtaining a license, permit, or identification card increased consent to donate organs among white and black participants.

Primary Funding Source: National Institutes of Health and the Robert Wood Johnson Foundation.




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Submit a Comment/Letter
Terminology in organ donation research needs to be clarified
Posted on April 16, 2012
MitchellLawlor, Honorary Associate, Ian Kerridge
Centre for Values, Ethics and the Law in Medicine
Conflict of Interest: None Declared

We would like to congratulate Thornton and colleagues for their investigation of an intervention aiming increase the rate of individuals declaring an intention to donate organs (1). We do however think that the terminology used in the article is inaccurate and should be clarified.

The subjects in their study are individuals applying for a driver's license, during which they are asked to indicate their intentions concerning organ donation. The paper describes this intervention as relating to "consent to donate organs". We feel this terminology unnecessarily, and undesirably conflates two different situations in organ donation research. The first situation (as in their paper) is individuals of the general community being asked what they would like to do should the possibility of donation arise. This should more accurately be referred to as investigating "intent" to donate organs. The second situation relates to the specific group of individuals who have made a real decision about donation in the context of a family member having died. We feel that only this situation should be referred to as "consent" to donate organs.

It is important to distinguish between these two groups as existing research suggests that while intention to donate is relatively high, actual consent to donation is substantially lower (2). Studies of intent and consent each provide valuable but different information, and the terminology suggested above should help to clearly distinguish between them.


1. Thornton JD, Alejandro-Rodriguez M, Le?n JB, Albert JM, Baldeon EL, De Jesus LM, et al. Effect of an iPod Video Intervention on Consent to Donate Organs: A Randomized Trial. Ann Intern Med. 2012 Apr. 3;156(7):483- 490.

2. Siminoff LA, Arnold RM, Caplan AL, Virnig BA, Seltzer DL. Public policy governing organ and tissue procurement in the United States. Results from the National Organ and Tissue Procurement Study. Ann Intern Med. 1995 Jul. 1;123(1):10-17.

Conflict of Interest:

None declared

Ipod Video Intervention And Organ Donation : The Dark Side Of The Force
Posted on April 24, 2012
AlexandreLoupy, M.D;Ph.D, Frank Martinez, Marie-France Mamzer
Kidney Transplant Department Necker Hospital, Paris, France
Conflict of Interest: None Declared

To the editor: We read with great interest the recent papers by Thornton et al (1) studying the Effect of an iPod Video Intervention on Consent to Donate Organs. In study, the authors nicely show that more participants who viewed the iPod Video video consented to donate organs than control participants (1). Given the discrepency between the supply of organs available for transplantation and demand, improving organ donation rate is a crucial topic (1). In this setting, iPod intervention may be deleterious, as reported by the Global Times newspaper article "Kid Sells Kidney for iPad 2, Regrets Transaction" (2). According to the journal, a 17-year-old student sold one of his kidneys just to buy an iPad and iPhone (2). The student foud an internet offer of 20,000 yuan (about $3100) for the transaction and had one of his kidney removed. The Southern Daily newspaper (3) further reported that other individuals have sold, or seriously considered selling, their kidneys to earn money for reasons that included paying off large debts, making a payment on a smartphone, or paying for an abortion for a girlfriend.

There is an emerging data in the literature showing the beneficial use of new technologies and social netwoks for public health intervention purposes (4). In this field, organ donation may be a particularly instructive example, because on one hand, adapted educational programs may prove efficient to enhance organ donation (1), while in another hand, new technologies, by increasing the speed and availability of information may have facilitated transplant commercialism or tourism (5). In this setting, significant efforts have been made to eradicate networks and track online chat rooms suspicious for making proselytism for unregulated sale of organs (5). These examples from China also raise the societal implications that "electronic devices" may take in the post modern life. Given our society's incessant search for satisfaction of all its desires and performance, acquiring such products might ultimately motivate extreme actions such as organ selling.


1. Thornton JD, Alejandro-Rodriguez M, Leon JB, Albert JM, Baldeon EL, De Jesus LM, et al. Effect of an iPod Video Intervention on Consent to Donate Organs: A Randomized Trial. Annals of internal medicine. 2012;156(7):483-90.

2. Zheng P. Boy regrets selling his kidney to buy iPad. Shanghai Daily. 2011.

3. Southern Chinese Daily News 2012.

4. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376(9755):1838-45.

Conflict of Interest:

None declared

Submit a Comment/Letter

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