Context— Since nearly all registered organ donors in the United States signed up via a driver's license transaction, motor vehicle (MV) offices represent an important venue for organ donation education. Objective— To evaluate the impact of organ donation video messaging in MV offices. Design— A 2-group (usual care vs usual care + video messaging) randomized trial with baseline, intervention, and follow-up assessment phases. Setting— Twenty-eight MV offices in Massachusetts. Intervention— Usual care comprised education of MV clerks, display of organ donation print materials (ie, posters, brochures, signing mats), and a volunteer ambassador program. The intervention included video messaging with silent (subtitled) segments highlighting individuals affected by donation, playing on a recursive loop on monitors in MV waiting rooms. Main Outcome Measures— Aggregate monthly donor designation rates at MV offices (primary) and percentage of MV customers who registered as donors after viewing the video (secondary). Results— Controlling for baseline donor designation rate, analysis of covariance showed a significant group effect for intervention phase (F= 7.3, P= .01). The usual-care group had a significantly higher aggregate monthly donor designation rate than the intervention group had. In the logistic regression model of customer surveys (n = 912), prior donor designation (β = −1.29, odds ratio [OR] = 0.27 [95% CI = 0.20–0.37], P < .001), white race (β = 0.57 OR = 1.77 [95% CI = 1.23–2.54], P = .002), and viewing the intervention video (β = 0.73, OR = 1.54 [95% CI = 1.24–2.60], P= .01) were statistically significant predictors of donor registration on the day of the survey. Conclusion— The relatively low uptake of the video intervention by customers most likely contributed to the negative trial finding.

Motor vehicle (MV) clerks are at the epicenter of organ donor registration. We show that MV clerks (n = 225) in two northeastern states have knowledge gaps and negative beliefs about organ donation. A majority believe it may be possible to buy organs on the black market (81%) and that recovery from brain death is possible (65%), whereas nearly half believe that doctors might not work as hard to save the life of a registered donor (46%). Organ procurement organizations should conduct formal educational programming with MV staff, considering their prominent role in the donor registration process.