Advances in TransplantationOrgan donation and procurementA Standardized Donor Designation Ratio to Assess the Performance of Driver's License Agencies

•DMV facilities play an integral role in consent for organ donation.•OPOs and others evaluate DMVs in part by how many of their patrons register to become organ donors.•Previous studies suggest that the characteristics of individuals influence their willingness to consent to donation.•Failure to account for individual characteristics of DMV patrons may lead to inaccurate assessments of DMV performance.•We developed the Standardized Donor Designation Ratio (SDDR) to better assess DMV performance while accounting for the characteristics of each DMV's patrons.

Evaluating Department of Motor Vehicles (DMV) locations based on the percent of patrons who register as donors does not account for individual characteristics that may influence willingness to donate. We reviewed the driver's licenses of 2997 randomly selected patients at an urban medical system to obtain donor designation, age, gender, and DMV location and linked patient addresses with census tract data on race, ethnicity, income, and education. We then developed a Standardized Donor Designation Ratio (SDDR) (ie, the observed number of donors at each DMV divided by the expected number of donors based on patient demographic characteristics). Overall, 1355 (45%) patients were designated as donors. Donor designation was independently associated with younger age, female gender, nonblack race, and higher income. Across 18 DMVs, the proportion of patients who were donors ranged from 30% to 68% and SDDRs ranged from 0.82 to 1.17. Among the 6 facilities in the lowest tertile by SDDR, 3 were in the lowest tertile by percent donation. In conclusion, there is a great deal of variation across DMVs in rates of organ donor designation. SDDRs that adjust for DMV patron characteristics are distinct measures that may more accurately describe the performance of DMVs in promoting organ donation.