title: Completion of advanced care directives is associated with willingness to donate.
abstract: OBJECTIVE
  A useful framework for initiating organ donation discussions in the primary care setting may help increase willingness to donate and thereby increase the frequency of organ transplantation. Given the lower willingness to donate among African Americans and that a higher proportion of African Americans die while waiting for an organ transplant, this is an important group to consider in such an approach. We examined the association among completion of a living will and willingness to donate and the influence of race in this relationship.
  
  
  METHODS
  A nationwide telephone interview survey using random digit dialing of households in high- and low-density African-American census blocks.
  
  
  RESULTS
  One hundred-eighty-eight adults participated (41% cooperation rate). In a multivariate model, factors associated with willingness to donate included having signed a living will (OR=2.43, 95% CI=1.13-5.23), talking with a physician about organ donation (OR=3.04, 95% CI=1.07-8.67) and white race (OR=2.5, 95% CI=1.23-5).
  
  
  CONCLUSIONS
  The public is generally supportive of organ donation although African Americans remain less willing to donate after controlling for confounding variables. Physicians interested in increasing donation rates should consider incorporating organ donation into discussions of advance care planning and end-of-life care.
authors.affiliation: Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, OH 44109, USA. john.thornton@case.edu
authors.forename: J Daryl
authors.initials: JD
authors.lastname: Thornton
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Margaret D
authors.initials: MD
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D016223:Advance Directives / Q000208:ethnology / Q000523:psychology*; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000208:ethnology; D011320:Primary Health Care; D014019:Tissue Donors / Q000523:psychology* / Q000600:supply & distribution; D009927:Tissue and Organ Procurement; D014481:United States