The need for transplantable organs in the Unites States is at a crisis level. Over 87,500 individuals are listed as transplant candidates by the Organ Procurement and Transplantation Network (OPTN) (http://www.optn.org), yet in 2004 there were only 14,140 donors. I find the problem of insufficient donors frustrating in light of transplantation outcomes. Survival rates are impressive and quality of life for recipients is high. With over 2.5 million registered nurses licensed in the U.S., we have a monumental opportunity to educate ourselves and others about the organ donation crisis. So what can we do?

Figure. Kathy B. Bean, PhD, RN, CGRN, APRN, BC, Editor

I see three key areas for increasing organ donation: minorities, rural settings, and "potential donor" families. Currently, 50% of those needing organs are minority, yet only 30% of donations in 2004 were from minority donors. The greatest need is for kidneys (n = 61,427): 40% of current candidates are listed as White, 35% as Black, and 17% as Hispanics (http://www.optn.org). Kidney donations according to ethnicity for 2004, however, were 70% White, 13% Black, and 13% Hispanic. Clearly, there is a marked disparity in minority participation in donation. So why aren't minority donation rates higher?

Reluctance to participate in donation by minorities is due to several factors: mistrust of the medical community, fear the donor will be neglected once a decision to donate has been made, lack of knowledge regarding brain death, apprehension regarding body-disfigurement and the opportunity for an open-casket funeral, concerns regarding ethnic bias in distribution of organs, and confusion regarding religious support of donation (Boulware et al., 2002; Callender & Miles, 2001; Durand, Decker, & Bruder, 2002; McNamara et al., 1999; Morgan & Cannon, 2003; Roark, 1999; Schutte & Kappel, 1997; Siminoff & Arnold, 1999). In response to these factors, nurses must become well-educated regarding the donation process to accurately and credibly address these issues with potential donors. We should take every opportunity to educate patients and their families regarding organ donation and be prepared to address apprehensions and misunderstandings with factual information. We should in particular be sensitive to minority concerns when discussing donation with patients and families of a minority background.

I believe another opportunity for increasing organ donation is in the rural setting where organ consent rates are traditionally low. Large medical centers have been the major focus of organ retrieval because they consistently produce the best donation rates (Sheehy et al., 2003). But large hospitals are already referring every potential donor and still the organ shortage continues (Shafer et al., 1998). Rural nurses should focus on potential donors from their hospitals and surrounding communities (Klassen, et al., 1999; McCoy & Bell, 1994). In fact, the smaller census in rural facilities may allow for more focused family attention when a death occurs. Because of the networking that exists in rural communities, a donor family's positive comments regarding their donation experience can result in more opportunities to increase public awareness and affect community participation in donation (McCoy & Bell). In fact, the influence of family networking is an important outcome of a positive donor experience in any hospital setting-rural or urban.

Opportunities to increase organ donation also occur at the bedside when families are approached to donate a loved one's organs. The strongest predictor of a family's decision to donate is the initial response to the donation request (Siminoff et al., 2001). For families who have discussed the donation decision with their loved one, the decision is typically easy. For families who have never discussed donation, the decision to donate can be difficult and stressful. For this reason, it is critical nurses encourage individuals to discuss their donation decision with their family.

Research suggests time spent with the family, as well as the donor and nondonor family experience of the donation process, are important factors in obtaining family consent (Siminoff et al., 2001). Preparing the family for imminent death contributes to informed decision-making and successful organ donation (USDHHS, 2003). In addition, establishing a strong relationship with the donor family and earning and maintaining their trust is critical in achieving consent to donate. In many instances of nondonor family decisions, a bond of trust between the nondonor family and the healthcare provider was never established, leading the family not to donate (DeJong et al., 1998). For this reason, nurses caring for these families should seek to develop a family communication plan. Initially, that means discussing the patient's grave prognosis, reviewing the plan of care with the family, assessing their understanding of the patient's prognosis, addressing all questions thoroughly and honestly, and adjusting the communication plan so effective communication about the patient's prognosis is established.

Nurses have a tremendous opportunity to impact the organ donation crisis. The 58 organ procurement organizations (OPO) in the U.S. are an excellent resource for obtaining accurate information regarding organ donation and the donation process (http://www.organdonor.gov/opo.htm). I have found the regional OPO to be a valuable source of expertise in organ procurement and staff is committed to working with nurses to develop effective strategies for improving donation rates.

A concerted effort to increase participation in organ donation is crucial. In particular, nurses working with minority clients and in rural settings have a great opportunity to impact donation rates. Collaboration with community organizations representing these groups can be particularly effective. In addition, nurses caring for potential donor families should do all they can to establish trust, provide accurate information, and facilitate an informed family decision regarding donation. I believe nurses can and should play a principal role in decreasing the disparity between the need for organs and donation rates. We can positively impact this crisis by using every opportunity to address the donation process and the critical need for organs.

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