are provided as an opportunity to assess progress, discuss outcome measures, and consider various evaluation methods.

It is important that HRSA better define the purpose of the grant program and expand the scope of projects considered for funding. The large number of funded public education grants raises the issue of whether the major aim of HRSA’s grant program is research or whether the program serves as a vehicle for funding public education on an ad hoc basis. Currently, funded projects must have the potential to “i) increase organ donation and ii) improve understanding of how to increase organ donation.” The first of these two goals severely limits the types of projects that can be funded, as projects that address only the second goal are ineligible for funding. Yet, projects of this nature may, in the long run, lead to system-wide changes that have a large impact on donation rates.

The limited resources for grant funding available to the Division of Transplantation in recent years have hindered the ability to explore additional innovative approaches and to scale up those interventions that have been found to be promising (see Chapter 1). The Division has leveraged the opportunities presented by the Organ Donation Breakthrough Collaboratives to incorporate new findings into the work of the hospitals and OPOs participating in the Breakthrough Collaboratives.

The committee believes that the Division of Transplantation should receive increased funding for its extramural program to support additional grants focused on innovative approaches to increasing organ donation rates (these projects, for example, examination of families’ acceptance of first-person consent, may or may not have a direct impact on donation) as well as projects whose findings are easy to translate into practice (for example, improvements to the request process and improvements to workplace registry programs). Ideally, projects would meet both requirements, but in practice there is often a trade-off between innovativeness and replicability.

Furthermore, HRSA should critically assess the findings of the studies that have resulted from previous grants and similar studies; give priority to projects that are highly innovative, replicable, or both; and consider funding some projects that will increase the knowledge base and serve as a foundation for future interventions or policy changes.


IOM (Institute of Medicine). 2005. Preventing Childhood Obesity: Health in the Balance. Washington, DC: The National Academies Press.

NRC (National Research Council), IOM. 2003. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: The National Academies Press.

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