title: Community-Based Interventions and Individuals' Willingness to be a Deceased Organ Donor: Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Widespread in-principle community support for organ donation does not necessarily translate to individuals becoming organ donors after death. Previous studies have identified factors that influence individuals' decisions to become organ donors, which may be effectively targeted by interventions. We aimed to describe and evaluate the effectiveness of community-based interventions to increase the willingness of individuals to be a deceased organ donor.
  
  
  METHODS
  We systematically reviewed all randomized controlled trials (RCTs), non-RCTs (NRCTs), and before-after studies that assessed the impact of interventions on increasing the willingness to be a deceased organ donor (measured as commitment to donate and/or intention to donate). We searched MEDLINE, Embase, PsycINFO, and CINAHL, without language restriction, to December 2013 and the reference lists of the included articles. We conducted a risk of bias assessment using the Cochrane risk of bias tools and assessed confidence in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation framework.
  
  
  RESULTS
  We identified 63 studies (11 RCTs, 8 cluster-RCTs, 4 NRCTs, 8 cluster-NRCTs, 27 before-after studies) with over 170,000 participants. Overall, the quality of the evidence was low. Participants who received a broad range of community-based interventions were more likely to commit as donors (7 cluster-RCTs; 6015 participants; relative risk, 1.70; 95% confidence interval [95% CI], 1.22-2.36; I = 94%, P = 0.002), and had higher levels of willingness to donate (3 RCTs, 393 participants; standardized mean difference, 0.29; 95% CI, 0.01-0.56; I = 45%; P = 0.04) than those who did not receive the interventions, but not the intention to donate (315 participants; relative risk, 1.19; 95% CI, 0.94-1.51; P = 0.14).
  
  
  CONCLUSIONS
  Community partnerships and active learning community-based interventions may be effective in increasing the commitment, but not intentions to donate. However, the overall risk of bias for was high, and this may have led to overestimation of the relative treatment effects of these interventions.
authors.affiliation: 1 Monash School of Medicine, Monash University, Victoria, Australia. 2 Sydney School of Public Health, University of Sydney, New South Wales, Australia. 3 Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia. 4 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia. 5 The George Institute for Global Health, Camperdown, New South Wales, Australia. 6 The Institute for Choice, University of South Australia, North Sydney, New South Wales, Australia.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Li
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Michelle
authors.initials: M
authors.lastname: Irving
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.forename: Angelique F
authors.initials: AF
authors.lastname: Ralph
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
mesh_terms: D006801:Humans; D016730:Program Development; D014019:Tissue Donors / Q000523:psychology*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*