Interventions to Increase Organ Donation: A Systematic Review

Access to organ transplantation is constrained by an insufficient supply of donor organs. Although many interventions address donation-related knowledge and attitudes, fewer assess outcomes such as registration, authorization, or donation.

To synthesize evidence on United States-based interventions designed to increase organ donation among adults.

Six databases were searched for English-language studies published between 2010 and 2023. Eligible designs included randomized trials, quasi-experimental studies, cohort studies, and pre-post studies reporting donor registration, authorization or consent, donation rates, or number of donors. Two reviewers independently screened and extracted records, and three reviewers completed Joanna Briggs Institute risk-of-bias (JBI) assessments. Findings were synthesized narratively.

Of 2206 identified records, 36 studies met the inclusion criteria: 13 randomized or cluster-randomized studies, 22 quasi-experimental studies, and one cohort study. Interventions were implemented in motor vehicle offices, healthcare settings, workplaces, universities, churches, community organizations, and online platforms. Effects were mixed. Immediate registration opportunities, interpersonal or peer engagement, staff involvement, and system-level workflow changes were more consistently associated with increased registration, designation, consent, and donation rates. Passive interventions with written materials and lower-intensity media interventions generally produced smaller or nonsignificant effects. Common limitations included lack of blinding, unclear allocation concealment, baseline differences, absence of concurrent controls, and residual confounding.

Interventions that reduce logistical barriers and actively engage participants appear more promising than education alone. Rigorous controlled studies are needed to identify scalable strategies, determine which approaches work across populations and settings, and inform efforts to narrow gaps between transplant demand and organ supply.