Organ Donation in the 50+ Age Demographic: Survey Results on Decision Rationale and Information Preferences.

529843 research-article2014

JAGXXX10.1177/0733464814529843Journal of Applied GerontologyTartaglia et al.

Article

Organ Donation in the 50+ Age Demographic: Survey Results on Decision Rationale and Information Preferences

Journal of Applied Gerontology 1–16 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464814529843 jag.sagepub.com

Alexander Tartaglia1, Diane Dodd-McCue1, Kevin A. Myer2, and Andrew Mullins3

Abstract The rate of organ donation by older potential donors is significantly declining even though recent studies show positive clinical outcomes with organs transplanted from older donors. This study examined the 50+ age demographic to identify the rationale for donation decisions, preferred media methods of donation information delivery, and responsiveness to an age-tailored donation message. Results from 579 surveys, 87% from the 50+ age demographic, found respondents prone to self-select themselves as medically ineligible based on current medication and health status, even though they might be medically suitable donors. Their incentive to pursue additional information on donation is limited except when motivated by personal accounts within their families and communities. In addition, even when computer literate, they continue to favor the printed or spoken word for donation information delivery. The results suggest an opportunity for

Manuscript received: May 29, 2013; final revision received: January 27, 2014; accepted: March 9, 2014. 1Virginia

Commonwealth University, Richmond, USA Houston, TX, USA 3Lions Eye Institute, Tampa, FL, USA 2LifeGift,

Corresponding Author: Alexander Tartaglia, School of Allied Health Professions, Virginia Commonwealth University, P.O. Box 980233, Richmond, VA 23298-0233, USA. Email: [email protected]

Downloaded from jag.sagepub.com at UNIV OF PITTSBURGH on November 15, 2015

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Journal of Applied Gerontology

those working with older adults to develop more personalized, localized donation education programs targeting this age demographic. Keywords organ donation, 50+ demographic, donation education

Introduction Although a Gallup Poll (2012) found that a majority of Americans support organ donation, the demand for organs available for transplantation continues to outstrip the supply, with the current gap widening. Efforts to promote organ donation include the establishment of statewide donor registries supported by federal and state sources. Since the Commonwealth of Virginia online donor registry (donatelifevirginia.org) was established in July 2000, an unpublished LifeNet Health review of donation patterns reflects significant decreases in registry designations as age increases. At a national level, the Association of Organ Procurement Organizations recognized this developing trend for the 50+ age demographic in presentations at its annual meeting in 2003-2004. At an international level, Van Leiden, Jansen, Haase-Kromwijk, and Hoitsma (2010) chronicled lower donation rates among older potential donors in the Netherlands. This downward pattern by older adults is in marked contrast with recent studies that focus on the clinical outcomes of transplantation using expanded donation criteria, including the use of organs from older donors. A recent review of 2000-to-2010 adult lung transplant data (Bittle et al., 2013) found that organs from donors aged 55 to 64 years were associated with outcomes of those observed with much younger donors, using donors aged 18 to 34 years as the comparison group. Other emerging evidence shows no statistically significant differences in clinical outcomes for transplant recipients receiving lungs (Pizanis et al., 2010) and kidneys (Cravedi, Ruggenenti, & Remuzzi, 2011; Lai et al., 2011) from older donors (>59) compared with younger donors. Berger et al. (2011) suggest that it is unclear from clinical evidence that identifying an upper age level for donation is appropriate for living donation of kidneys. Information provided to kidney transplant candidates (e.g., “Talking About Transplantation”) addresses the merits of older donors, particularly for dialysis patients. In short, increased organ donations by older adults could result in the potential for more life-saving transplants without negatively affecting transplant recipient outcomes. An Ohio study (Downing & Jones, 2008) found that individuals in the 50+ age demographic may respond more positively to organ donation if discussions/


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requests are personal in nature, highlighted by a recipient’s experience, supported by printed material, and resulting from an outgrowth of family discussion. This research also suggests that this age demographic may be less responsive to a donation message that is generic and/or conveyed through broadcast or Internet media alone. These findings imply that although individuals in this age demographic tend to support organ donation, they may not register as donors because of eligibility misinformation (Downing & Jones, 2008). This research is supported by recent studies suggesting that personal approach and discussion during license renewal may be superior to online registration to secure wishes about organ donation (Hajhosseini, Stewart, Tan, Busque, & Melcher, 2013; Lawlor & Kerridge, 2009). Few systematic campaigns have focused on increasing donation registration in the 50+ age demographic, with the majority of grant-funded public education efforts directed at college students or young adults (“Health Resources and Services Administration [HRSA] Public Education Efforts”). Although evidence hints that mass media education campaigns may not be effective with this older age group, no published studies have relied on highly personal discussion. This study project examined organ donation patterns among the 50+ demographic by developing and piloting targeted messages designed to increase donation in this population segment. Three research questions guided this project: Research Question 1: What is the rationale of those in the 50+ age demographic for registering (or not registering) as organ donors? Research Question 2: What are the preferred media methods for increasing donation registration rates among the 50+ age group? Research Question 3: Will this age group respond positively to a tailored message on organ donation?

Method The study intervention was a five-item verbal scripted survey (Appendix A) developed by the project team with assistance from local Organ Procurement Organization (OPO) staff involved with community education. Preliminary preparation for the survey’s development included assistance from students in mass communication who identified strategies to communicate organ donation and transplantation information to Virginia residents in the 50+ demographic. In addition, the survey incorporated the results from a focus group representing that age group. Focus group participants were 10 residents randomly selected from an active adult community, with racial and gender membership representative of the geographic area. Although almost


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half of the group was computer savvy and acknowledged they had actively sought information about medical conditions online, they expressed a strong preference for face-to-face interpersonal delivery of medical information and printed materials. The intervention, which incorporated their recommendations for localized, event-specific delivery of donation/transplantation information using a personalized approach, was piloted with OPO staff not involved in the project and evaluated by an expert panel from an academic medical system’s Organ Donation Committee. The survey was tailored for nondonors and included general and age-tailored questions about donor status, registration medium, and donation message preferences. The survey was designed to further response-triggered discussion of donation using scripted talking points. Face-to-face interventions were conducted by trained OPO staff and volunteers. All persons conducting the intervention were trained to respond to participant responses to the scripted survey. In addition, they received human subjects’ protection training using an established Institutional Review Board (IRB) approved curriculum for conducting community-based research. Training was conducted by one of the authors who also secured IRB approval (HM 12483). The survey and corresponding script appear in Appendix B. The research design used a nonexperimental post-intervention observation design using a convenience sample of attendees at six events. Three of the events were community-based education events such as local centers for lifelong learning that target the 50+ demographic. The others were large seasonal festivals conducted annually at outdoor settings. These were multi-day, intergenerational targeted family events with overall attendance exceeding 2,500. Each festival historically attracted a cross section of the community, with representation from a range of demographic and socio-economic groups. At the local education events, participants were verbally informed of the study with an invitation to participate as they exited. At the larger public festivals, the survey population was visually identified by interview staff and volunteers as falling in the 50+ age demographic. Paper (and when possible, electronic) means of registering with the organ donation registry were available at each site. Paper donation registration forms were coded by location, and individuals who registered electronically were asked the additional question of whether they spoke to an OPO volunteer that day.

Results and Findings A total of 579 surveys were completed, with 506 (87%) survey respondents falling into the 50+ age demographic. The organ donor registration status for the target population identified by age appears in Table 1.


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Tartaglia et al. Table 1. Survey Respondents by Age and Donor Registration Status. In targeted age (N = 506) 51-60 61-70 71+ Total

Yes

No

128 (25%) 113 (22%) 63 (13%) 304 (60%)

51 (10%) 69 (14%) 82 (16%) 202 (40%)

Table 2. Registration Route of Registered Donors in Target Age Group. DMV Paper Online Unreported data

268 (88%) 17 (5.5%) 5 (1.5%) 14 (5%)

Of survey respondents in the age 50+ demographic, 304 were registered organ donors (60%) with the highest percentage (25% of the total target group) falling into the 51 to 60 sub-group. Two hundred two were not registered as organ donors (40%) with the highest percent of nonregistrants (16% of the total target group) falling into the 71+ sub-group. When identifying the mechanism by which 50+ aged individuals registered their wish to donate, the Department of Motor Vehicles (DMV) was overwhelmingly the preferred route (n = 268, 88%). Only 17 (6%) reported registering with paper forms, and only 5 registered donors (2%) reported registering online (Table 2). Fourteen (5%) of those surveyed did not respond to this question. Unless specified otherwise, the remaining and following results are reported on the 202 respondents in the 50+ age demographic who were not registered as organ donors. All percentages are based on the total N of nonregistered donors. Survey data in response to each of the survey questions may not add to 100% as a result of missing or unreported data.

Not a Registered Organ Donor Because When asked a general question about not choosing to become registered donors, respondents offered varied but vague reasons. “Haven’t given it much thought” was the most frequently mentioned reason (74, 37%), followed by “other reasons” (57, 28%) and “decided against” (44, 22%).


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Rationale for No Organ Donation Decision When asked more specific questions regarding not registering as an organ donor, only 92 of the 202 offered specific reasons. The reasons included “current health” (46, 23%), “too old” (43, 21%), and both “age and health” (3, 1%). These overshadowed religion, open casket, and family objections, which were not recorded as having been mentioned. Within age specific subgroups, the percentage listing “current health” was consistent in 51 to 60, 61 to 70, and 71-plus categories. The response “too old” was used most often by those 61 and older. The largest number of respondents (81, 40%) indicated “Other” with no specific reason documented.

Suggested Aids to Organ Donor Decision When asked about resources that might assist subjects in making a donation registration decision, “available reading material” was most frequently noted (52, 26%), followed by “understanding more regarding misconceptions” (28, 14%), and “speak with organ transplant recipient” (23, 11%). Less frequently seen as aiding the donation decision were “local stories on TV” (16, 8%), “being told/encouraged by family member” (20, 10%) and “speak with donor family” (12, 6%).

Register Today The survey process only led to “yes” to the question about registering today for a minority (35, 17%), whereas the majority (154, 76%) remained a “no” decision. Restated, almost three times as many remained unchanged after the survey conversation. Thirteen (7%) did not respond to this question.

Registration Route if Today Almost 80% (161) of those nonregistered organ donors surveyed in the 50+ group did not respond to the question about their preferred donation registration route, were they to register that day. For those who did respond, “paper” was identified as their desired route (24, 12%). “Online” (17, 8%) was less frequently identified as the preferred registration route.

Accept Organ Donation Information to Review Of the 167 individuals who elected not to register the day of the survey, the majority (111, 66%) said “yes” to taking additional information to review on


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organ donation and the donor registration process. Only 29 (17%) specifically declined further information.

Preferred Information Source When the 167 who did not register the day of the survey were asked about the preferred medium for donation information, paper brochure was clearly favored over all other information sources. More than twice as many (73, 44%) preferred paper brochures to television (30, 18%) and “hearing in person from transplant recipient or donor family” (23, 14%). Even fewer (14, 8%) cited the Internet as their preferred information source.

Preferred Registration Route in Future When the same 167 sub-group were asked about a preferred registration route should they elect to register as a donor in the future, paper (70, 42%) and DMV (51, 30%) were most frequently identified. The Internet was acknowledged as the desired route by only 28 (14%).

Other Results A correlation table finds multi-collinearity: The majority of items were related and often at some level of statistical significance. This suggests that there was little discrimination between many of the questions posed. The responses did not reflect a normal distribution. The study did not capture response rates to invitations to participate in a systematic or measureable manner. OPO volunteers, however, did report that in the “fixed” population contexts, more than 80% of event attendees participated in the survey and that at the large public events, only a “handful” of those approached refused to participate in the survey.

Discussion This study was successful in addressing its first objective: identifying the rationale underlying the 50+ demographics decisions to not register as organ donors. The findings suggest that members of this age demographic are prone to self-select themselves as medically ineligible for donation based on age as well as current medication and health status, although they are knowledgeable and actively seek additional information on medical issues. The study was also successful in identifying the second objective, the delivery preferences of this age demographic. This supports the findings of Downing and


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Jones (2008). Regardless of Internet experiences, the printed word in paper form and a personalized approach are preferred. This study indicated that those not registered as organ donors had a variety of concerns related to their decision and were receptive to information, but it did not demonstrate that they could be persuaded to change their position, at least not in the short run. This suggests the appropriateness of a longitudinal study to capture attitudinal changes that might later be associated with behavioral change. However, the benefits of a longitudinal design are tempered by the influence of numerous extraneous variables that could affect the donation registration decision. For example, the unexpected medical crisis of a loved one could serve as an impetus to donation registration, regardless of the potential registrant’s self-assessment of medical suitability. Study results should be interpreted in light of the potential bias introduced by self-reported responses. The responses provided by study participants may have been influenced by social desirability, their perception that social norms favor organ donation, and their reluctance to respond in ways that oppose this norm. For example, some respondents may have indicated an unwillingness to register as potential donors due to medical reasons rather than speak about less-concrete feelings of personal discomfort about organ donation. Responses also may have been influenced by a critical event (outcome of transplant of friend or well-known community member) or self-fulfilling prophecy, commenting in light of perceptions of the desired study outcome. The methodological limitations of this study include the use of a nonrandomized convenience sample and no measured response rate, both of which could be addressed through redesign. Self-report response bias could be addressed through thoughtful interpretation of results. Despite these limitations, the study points to opportunities for the use of a tailored survey to introduce the topic of organ donation. The survey tool and scripted text served as valuable resources to promote and direct effective discussion for this age group. This survey and technique can be readily replicated with trained volunteers. Given the trends in registration since this project was initiated, continued efforts toward promoting donation/transplantation understanding of the 50+ demographic are warranted. This project affirms the value of targeted campaigns to address this under-represented group with more personalized, localized approaches from the perspective of increasing donation registration information. It suggests that outreach targeting the 50+ demographic may require higher touch efforts to address misinformation regarding age and health compatibility with donation. The number of nonspecific responses to individual survey questions resulting in “other” or “missing data” may have


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implications for future investigation and the level of public comfort in discussing organ donation. As cost pressures increase for OPOs, shrinking outreach budgets may be more efficiently used through market segmentation. Current efforts to refine state registries could include use of age categories to collect and retrieve trend data more effectively. Routine, standardized registration information by age, date, and locale would allow for identification of the impact of more targeted localized interventions as well as areas where future efforts at donation promotion are recommended. The results of this study suggest an opportunity for community centers on aging as well as those who develop education programs for older adults. Given the expanded criteria for eligibility of organ donation, this study identifies the 50+ age demographic as a potentially untapped group who could affect the national shortages of solid organs available for transplantation.

Appendix A Organ and Tissue Donation Survey Age group Please circle one: 18-40 41-50 51-60 61-70 71+ 1. Are you a registered organ and tissue donor?

□ Yes □ No a. If Yes, how did you register your decision? □ Online □ DMV □ Paper form

The section below is only for those individuals who are not registered: 2. I am not a registered organ donor because:

□ I just have not given it much consideration; no particular reason. □ I am leaving that decision for my family if and when that time comes. □ I have given it some thought and decided against it for now. □ Other__________________________________

3. Which of the following items below has kept you from making the decision to become an organ and tissue donor?


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□ I am too old. No one would want my organs. □ It is against my religion. □ My current health condition would keep me from being able to be a donor. □ I want to be able to have an open casket funeral. □ My family would not want me to be an organ and tissue donor. □ Other___________________________________

4. Which of the following items below would most likely help you make the decision to become an organ and tissue donor?

□ Speaking with someone who has received a transplant. □ Speaking with a donor family member. □ Understanding more regarding myths and misconceptions of donation. □ Having donation material available to read. □ Having your family members telling you to register to become a donor. □ Seeing local stories on TV regarding individuals whose lives have been saved by donation and transplantation.

5. After speaking with me today, would you like to register to become an organ and tissue donor?

□ Yes □ No a. If yes, which method would you prefer to register by today: □ Online □ On paper b. If no, would you be willing to take more information to review? □ Yes □ No c. What would your preferred source of information about donation be?

□ Paper brochure □ TV Radio □ Hearing in person from a transplant recipient or donor family Seeing a billboard □ From my church □ Internet/Social media d. If you were to register to become a donor in the future, which way would you prefer to register your decision by?

□ Online □ DMV □ Paper form


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Appendix B Volunteer Surveying Script Specifically try to target those individuals who you feel will fit into the 50+ age demographic. 1. As you approach each individual, please ask them whether they would be willing to participate in a brief survey on organ and tissue donation. Indicate that you are participating in a study on opportunities to increase donation and to ultimately save lives. You should indicate that participation in the study is voluntary and their responses are not identifiable. There may be no direct benefit for them, but they will receive a small gift certificate to a local retailer as appreciation for their time. At the end of the survey, you will be offered the option of receiving information about how to become an organ donor today or in the future. 2. Ask each person which age group best fits them: 18-40, 41-50, 51-60, 61-70, 71+ Please circle the response that they give you. 3. Ask each person, “Are you a registered Organ and Tissue donor?” Check the appropriate response (either “Yes” or “No”)

a. If they say “Yes,” thank them for doing so and ask them where they registered their decision to become an organ and tissue donor. Check the appropriate box (choices are “online, “DMV,” or “paper form”) b. If they say “No,” please ask them the remaining questions on the survey (see below) The questions below are only for those individuals who are not registered: 4. Have them answer the following question, “I am not a registered organ donor because”:

□ I just have not given it much consideration; no particular reason. □ I am leaving that decision for my family if and when that time comes. □ I have given it some thought and decided against it for now. □ Other _____________________________


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Check the appropriate response. If they offer another reason, check “Other” and write what they say verbatim. 5. Ask “Which of the following items below has kept you from making the decision to become an organ and tissue donor?”

□ I am too old. No one would want my organs. □ It is against my religion. □ My current health condition would keep me from being able to be a donor. □ I want to be able to have an open casket funeral. □ My family would not want me to be an organ and tissue donor. □ Other

Check the appropriate response. If they offer another reason, check “Other” and write what they say verbatim. 6. Ask “Which of the following items below would most likely help you make the decision to become an organ and tissue donor?”

□ Speaking with someone who has received a transplant.

If this box is selected, tell them one of the following: “ Several of our volunteers here today are transplant recipients, including ________who are over at the LifeNet Health display.” “ I’m a kidney transplant recipient myself. I received this gift 7 years ago. Without it I’d not be talking to you today.” “ In Virginia there are ________ organ recipients. And there probably will be at least __________ new recipients in Virginia this year alone. But keep in mind the demand for organs to transplant greatly outweighs the number of patients who get this gift.”

□ Speaking with a donor family. If this box is selected, tell them one of the following: “ Several of our volunteers here today are members of donor families, including ________who are over at the LifeNet Health display.” “ I’m a kidney donor myself. I made this gift 7 years ago. Without it my daughter would not be here today.”


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“ In Virginia there are ________ organ donors each year. But keep in mind the demand for organs to transplant greatly outweighs the number of patients who get this gift. Today there are ________ on the transplant list awaiting the gift of donation.”

□ Understanding more regarding myths and misconceptions of donation

If this box is selected, tell them the following: “ This is a complicated topic. If you are interested in learning more . . . (direct to lit, online info, table at event, mention volunteers eager to discuss, etc.)”

□

Having donation material available to read

If this box is selected, tell them the following: “I’m happy to give you a brochure” or “The volunteers at our display would be happy to provide you with some reading materials on donation.” Or mention where might also be available publicly (i.e., DMV as well as online)

□ Having your family members telling you to register to become a donor

If this box is selected, tell them the following: “ That’s a good point. It is important for families to discuss this decision. Here is some information for you that you could also share with them.”

□ Seeing local stories on TV regarding individuals whose lives have been saved by donation and transplantation

If this box is selected, tell them the following: “ There are highly publicized cases, like Alonzo Mourning, the NBA player who received a kidney a few years ago. He was interviewed on TV recently—think he’s a Virginia native even—and is doing well. Recently (name local paper, give example of most recent press; or name local television station, give example of more recent press) There are some inspiring stories out there—and there are all possible because of the donation decision.”


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7. Ask, “After speaking with me today, would you like to register to become an organ and tissue donor?” If they say “yes,” ask them whether they would prefer to register “online” or “on paper.” Check the appropriate box. If they say “yes,” please help facilitate the individual’s decision to donate either by registering “online” or “on paper.” If they say “no,” please proceed with asking the following questions: a. Ask them, “Would you be willing to take more information to review?” Check appropriate response. b. Ask them, “If you were to register to become a donor in the future, which way would you prefer to register your decision by.” Check the appropriate box choosing from: □ Online □ DMV □ Paper form c. Ask them, “What would your preferred source of information about donation be?” Check the appropriate box choosing from the following: □ Paper brochure □ TV □ Radio □ Hearing in person from a transplant recipient or donor family □ Seeing a billboard □ From my church □ Internet/Social Media Authors’ Note The contents of this article are solely the responsibility of LifeNet Health (the grantee organization) and do not necessarily represent the official views of the Health Resources Services Administration.

Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by Grant R390T07541 (FY2005) from the Health Resources and Services Administration (HRSA), Office of Special Programs, Division of Transplantation.

References Berger, J. C., Muzaale, A. D., James, N., Hogue, M., Wang, J. M., Montgomery, R. A., . . . Segev, D. L. (2011). Living kidney donors ages 70 and older: Recipient


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and donor outcomes. Clinical Journal of the American Society Nephrology, 6, 2887-2893. doi:10.2215/cjn.04160511 Bittle, G. H., Sanchez, P. G., Kon, Z. N., Watkins, A. C., Rajagopal, K., Pierson, R. N., . . .Griffith, B. P. (2013). The use of lung donors older than 55 years: A review of the United Network of Organ Sharing database. The Journal of Heart and Lung Transplantation, 32, 760-768. doi:10.1016/j.healun.2013.04.012 Cravedi, P., Ruggenenti, P., & Remuzzi, G. (2011). Old donors for kidney transplantation: How old? Gerontology, 57, 513-520. doi:10. 1159/000320720 Downing, K., & Jones, L. (2008). Designing an educational intervention to increase organ donation among older adults. Progress in Transplantation, 18, 290-296. Gallup Poll. (2012). Retrieved from http://www.organdonor.gov/dtcp/nationalsurveyorgandonation.pdf (2013). Hajhosseini, B., Stewart, B., Tan, J. C., Busque, S., & Melcher, M. L. (2013). Evaluating deceased donor registries: Identifying predictive factors of donor designation. American Surgeon, 79, 235-241. Health Resources and Services Administration Public Education Efforts to Increase Solid Organ Donation–Grantees–Fiscal Years 2007-2012. Retrieved from http:// www.organdonor.gov/dtcp/publiceducation..html (2012) Lai, Q., Nudo, F., Levi Sandri, G. B., Melandro, F., Ferreti, S., Geico, M., . . . Berloco, P. M. (2011). Survival after kidney transplantation does not differ with 50-59- or over 60-year-old expanded criteria donors. Transplant Proceedings, 43, 10301032. doi:10.1016/j.transproceed.2011.01.038 Lawlor, M., & Kerridge, I. (2009). Registering wishes about organ and tissue donation: Personal discussion during license renewal may be superior to online registration. Internal Medicine Journal, 39, 835-837. Pizanis, N., Heckmann, J., Tsagakis, K., Tossios, P., Massoudy, P., Wendt, D., . . . Kamler, M. (2010). Lung transplantation using donors 55 and older: Is it safe or just a way out of organ shortage? European Journal of Cardio-Thoracic Surgery, 38, 192-197. doi:10.1016/j.ejcts.2010.01.054 Talking about Transplantation - Information for Kidney Transplant Recipients and Their Families_(2005). Retrieved from http://optn.transplant.hrsa.gov/ SharedContent-Documents/ExpandedCriteriaDonor_KidneysBrochure.pdf Van Leiden, H. A., Jansen, N. E., Haase-Kromwijk, B. J., & Hoitsma, A. J. (2010). Higher refusal rates for organ donation among older potential donors in the Netherlands: Impact of the donor register and relatives. Transplantation, 90, 677-682.

Author Biographies Alexander Tartaglia, DMin is Senior Associate Dean in the School of Allied Health Professions and Katherine I. Lantz Professor of Patient Counseling. A healthcare chaplain by training, he has published in diverse areas such as organ donation, pastoral education, and ethics. Diane Dodd-McCue, DBA is Associate Professor of Patient Counseling. She currently teaches research methods for both masters and doctoral students. She has


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published in the areas of organ donation, pastoral education, and organizational behavior. Kevin A. Myer, MSHA has 20+ years of experience in organ donation leadership. He is currently President and Chief Executive Officer of LifeGift. Prior to his arrival at LifeGift, he served as business director of the Center for Transplant System Excellence at the United Network for Organ Sharing (UNOS). Andrew Mullins, MBA is currently the Director of Ocular Services with the Lions Eye Institute for Transplant and Research. In his previous position, he served as Director, Hospital Development and Community Education, at LifeNet Health in Richmond, VA.


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