CHAMPAIGN, Ill. – Illinois in 2006 joined other states in creating a first-person, legally binding consent registry for organ donation. Now the task is persuading more people to sign up, including those newly eligible each year when they turn 18.
But how do you reach these teenagers in a multimedia age?
Try a letter, says Brian Quick.
Turns out that the least-flashy method might be one of the best – and certainly most cost-effective – based on a study of a December 2010 direct-mail campaign directed at 140,000 Illinois 18-year-olds.
Quick, a professor of communication at the University of Illinois specializing in health communication, was the lead author of the study, published online March 15 by the American Journal of Transplantation. Co-authors were Dave Bosch, director of communications at Gift of Hope Organ & Tissue Donor Network, and Susan Morgan, a professor of communication at Purdue University.
For the campaign, about a third of the 140,000 18-year-olds were sent a color brochure, with photos on the cover of three children saved by organ donation and the title “Be a Hero, Save Lives.” The brochure had been developed with information gathered from Illinois young adults through focus groups and phone surveys.
Another third received a standard-issue, nine-sentence letter from the Illinois Secretary of State, telling them their decision to become an organ and tissue donor “is one that you can now make legally.”
The other third received both the letter and the brochure.
But it was the letter that proved most effective by far, Quick said. Those receiving the letter alone registered at almost double the rate of those who received only the higher-cost brochure, which was “kind of shocking,” he said.
After accounting for mailings returned as undeliverable, the registration rates were 6.24 percent for those receiving only the letter, 6.30 percent for those receiving both the letter and brochure, and 3.30 percent for those receiving only the brochure.
(Even the lowest rate would be considered successful, given the serious nature of the request, Quick said. The average response rate for direct mail to a prospect list is 1.38 percent, according to figures he cited from the Direct Marketing Association.)
The difference in the rates between those receiving only the letter and those receiving both the letter and brochure was statistically insignificant, indicating the brochure had little apparent benefit and was not worth the added cost, he said.
Given the registration rates, the undelivered mailings, and the various costs of materials and mailing, the average cost per registration was $13.19 for those receiving only the brochure, $7.15 for those receiving both items, and $6.41 for those receiving only the letter, Quick said.
As to why the letter was so much more effective, the study could not determine, but it may be a matter of simply cutting through the multimedia clutter, Quick said.
Young adults now receive numerous slickly produced brochures from groups as diverse as college admissions offices and military recruiters, as one teenager noted in a focus group, Quick said. “It’s easy to think fancy is better, but fancy’s now the norm. A standard letter from the Secretary of State isn’t the norm.”
The letter also looks official, is personalized with the recipient’s name, and tells them their decision to become a donor is their own. For 18-year-olds who “don’t like being told what to do,” that can be read as empowering, Quick said.
Just as surprising among the results from the campaign: Nearly three-quarters of those who registered chose to mail in their form rather than go online, even though both the brochure and letter promised online signup could be done in 30 seconds.
Among those who registered after receiving the letter alone, or the letter and brochure together, 63.4 and 70.2 percent respectively mailed in their registration. Among those who received only the brochure, the rate was 90.5.
Quick could only guess as to why, but suggested that maybe the respondents, from a generation raised with the Internet, were leery about registering this important decision online.
No matter what materials they received or how they responded, the study showed the benefit of promoting organ donation among this age group, and the value of direct mail in doing so, Quick said. Nearly 7,000 18-year-olds were registered at an average cost of $8.21, or $56,687 overall.
Both the campaign and the study were supported by the Health Resources and Services Administration’s Division of Transplantation, in the U.S. Department of Health and Human Services.
As a result of the campaign’s simplicity and cost-effectiveness, especially when sending only a letter, other states are working to duplicate it, Quick said.
The findings are important, he said, because teenagers might hear about organ donation in the process of getting their licenses at age 16, then maybe not again until age 21, when those with good driving records must renew their licenses. Getting more people on the registry, and when they’re first eligible, means more chances for the more than 100,000 people in the U.S. waiting for organs, he said.
“We figure that for every 100 registered organ donors, between one and two of them will die in a manner that allows their organs to be donated,” Quick said, “but one person can save up to eight lives and improve up to 25 others.”
