Options for Increasing Organ Donation: The Potential Role of Financial Incentives, Standardized Hospital Procedures, and Public Education to Promote Family Discussion WILLIAM DEJONG, JESSICA DRACHMAN, STEVEN L. GORTMAKER, ET AL.* Harvard University; Partnership for Organ Donation , Boston R ig h t n o w , mo r e t h a n 37,000 A m e r ic a n s a r e waiting for an organ transplant to restore their good health (United Network for Organ Sharing 1994). Sadly, with their hopes for a medical miracle left unfulfilled, nine of these people will die today, and another nine every day this year. A shortage of organs exists despite the fact that there are more than enough potential organ donors to meet current needs. State and federal laws that require hospital personnel to make requests for organ and tissue donations have not closed the gap (Caplan et al. 1991). Ultimately, the scarcity of organs leads to public skepticism about the integrity and fairness of the nation’s organ distribution system. Most recently, the public’s concerns were underscored by allegations of pref- erential treatment for Governor Robert P. Casey of Pennsylvania, who received a heart-liver transplant at Pittsburgh’s Presbyterian University Hospital (Colburn 1993). The fear is that these concerns will decrease the public’s willingness to donate (Caplan 1992). The continuing shortage of organs for transplant, coupled with a growing pessimism among medical professionals about the failure of ed- ucation efforts to “sell” the public on organ donation, is inspiring in- *Coauthors are listed at the end of the article. The Milbank Quarterly, Vol. 73, No. 3, 1995 © 1995 Milbank Memorial Fund. Published by Blackwell Publishers, 238 Main Street, Cambridge, MA 02142, USA, and 108 Cowley Road, Oxford OX4 1JF, UK. 463