Policy effectiveness and instrument selection: An examination of United States organ and tissue donation policies.

Continuing advances in medical technology have made organ and tissue transplantation safer and more effective. However, organ and tissue donation has not increased at a similar pace. In order to promote donation and transplantation, federal and state governments have assumed an active role in educating citizens about the need for organs and tissues. This research examines why this policy area developed the way that it did and how effective it has been. I examine the need for a new policy typology and argue that policy type influences instrument selection. More specifically, I examine the effectiveness of policy changes in certain states that have reaffirmed and enforced drivers\u27 licenses, donor cards, advanced directives, and enrollment in a donor registry as legally binding documentation for donation. This change is controversial because the next-of-kin of the deceased person will be notified regarding donation of organs and tissues, but do not have to approve the initiation of donation procedures. Used as a policy tool, these legally binding policies target change in two groups: the general public and health care professionals. The study employs elite interviews and pooled time series analysis. My findings suggest that the enforcement of the legally binding policy and the presence of a donor registry influence cadaveric donor rates, but do not influence registered donor rates. While these strategies are helping to curb the shortage of donors, they are not a cure-all solution. A better understanding of the impact of these changes is important because they are an attempt to use certain policy tools to influence the choices that individuals make. I believe this research contributes to the health policy literature by further examining policy issues such as presumed consent. This issue is also timely in regard to the continuing debate concerning the boundaries of government regulation in health-related topics