OMB control number 0915-0290 Expiration XX/XX/XXXX
NATIONAL SURVEY OF ORGAN DONATION ATTITUDES AND PRACTICES
Computer-Assisted-Telephone-Interviewing (CATI) Script (English Version)
Public Burden Statement: The overall purpose of this study is to conduct an independent survey of public opinion regarding various issues related to organ donation. This Data is essential for planning, targeting, and implementing outreach efforts to increase public donation commitment as well as for tracking the results of such efforts over time. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-0290 and it is valid until XX/XX/202X. This information collection is voluntary. Data will be private to the extent permitted by the law. Public reporting burden for this collection of information is estimated to average 17 minutes (0.29 hours) per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857 or [email protected].
PROJECT – HRS R658
INTRO1
Hello, my name is _______, and I am calling from American Directions Research Group. I am calling on behalf of the U.S. Department of Health and Human Services. We’re conducting a national survey about organ donation. Am I speaking to someone 18 or older? (Skip: If “Yes”, continue; if “No”, ask to speak to someone who is 18 or older)
Respondent available –(Continue)
No one 18 or older in household – (Thank and Terminate)
Respondent not available/Not a good time –(Set time to call back)
(Soft Refusal)
(Hard Refusal) –(Thank and Terminate)
(Skip this question if cell/landline data present in the sample file)
S1B Have I reached you on a cellphone or landline phone?
Landline
Cell
(Don’t Know)
(Refused)
(If S1B = Landline)
S1 First, I would like to identify the adult living in your household, 18 or older, who had the most recent birthday. Who would that be?
Respondent –(Skip to S1B)
Someone else in household –(Ask to speak to that person, then reset to Introduction)
No adults 18 or over in household – (Thank, Terminate, and Tally)
Respondent not available – (Record First name and set time to call back)
(Refusal) – (Thank and Terminate)
(If S1B = Cell)
S1C For your safety, are you currently driving?
Yes [SET CALLBACK IF DRIVING, ELSE CONTINUE]
No
(Don’t Know)
(Refused)
INTRO 2 (web landing page text)
This is an important study of people’s opinions about organ donation. Your assistance in this study is voluntary, but your opinions are needed to provide an accurate understanding of the public’s views. If there is any question you do not wish to answer, just tell me. Your answers are confidential and will be combined with those of others. You, as an individual, will never be identified. The questions will require about 20 minutes of your time.
CONSENT May I have your consent to start the interview?
Yes (continue with Q1A)
No (terminate call)
[IF NECESSARY READ] By ORGAN DONATION, I mean the donation of organs, such as hearts or kidneys from a person who has died, or the donation of organs, such as kidneys or parts of a liver or lung, from a person who is alive. Transplantation is the surgical transfer of an organ from one person to another. Organ donation does not include the donation of bone marrow or tissue, such as skin or corneas.
Q1A Thinking about the last 6 months, do you remember hearing or seeing anything about organ donation and transplantation?
Yes
No
(Don’t know)
(Refused)
Q1B (If Q1A = Yes) How would you describe what you heard or saw about organ donation in the past 6 months?
Mostly positive
Mostly negative
Both positive and negative
(Don’t know)
(Refused)
Q2F Thinking about the last 6 months, do you remember hearing or seeing anything about how to sign up to be an organ donor?
Yes
No
(Don’t know)
(Refused)
Q2G (If Q2A = Yes) Where did you see information about how to sign up to be an organ donor?
[RESPONSE CODES]
Yes
No
(Don’t know)
(Refused)
How about [READ AND ROTATE]:
A discussion with a friend or family member
Information provided by a medical professional, clinic, or doctor’s office
A billboard or a poster in a public place
News coverage (TV, radio, newspaper, or internet)
A Motor Vehicles Office (MVA, DMV, or SOS)
An advertisement on TV
An advertisement on the radio
An advertisement on the web
A community activity, such as a health fair
An organ or tissue donation organization
Social media such as Facebook, Instagram, YouTube, or Twitter
On a website other than social media
Some other source
Q3 Which sources of information would be most likely to influence how you think or act about organ donation? [open-ended response RECORD VERBATIM]
Q4 In general, do you strongly support, support, oppose, or strongly oppose the donation of organs for transplantation?
Strongly support
Support
Oppose
Strongly oppose
(Don’t Know)
(Refused)
Q13 Are you signed up to be an organ donor?
Yes
No
(Don’t Know)
(Refused)
Q13A (If Q13 = Yes) (rotate Q13A A-D) How did you sign up? (Select all that apply)
Yes
No
(Don’t Know)
(Refused)
During a transaction at your motor vehicle office or website
At a donor registration drive or event
Through a mobile phone app
Through a website other than during a motor vehicle transaction
Through the Department of Defense as a member of the US military
Some other way
Q13B (If Q13A=E ‘Some other way’)
What other way did you sign up to be an organ donor? [open-ended response RECORD VERBATIM]
Q13D (If Q13 = No)
Have you ever signed up as an organ donor?
Yes
No
(Don’t Know)
(Refused)
Q5 (If Q13 NOT = Yes)
Would you want your organs to be donated after your death? Would you say definitely yes, probably yes, probably no, or definitely no?
Definitely Yes
Probably Yes
Probably No
Definitely No
(Don’t Know)
(Refused)
Q14B (If Q5 = definitely yes or probably yes)
Would you be willing to sign up to be an organ donor?
Yes [SKIP TO Q14D]
No [SKIP TO Q14C]
(Don’t Know)
(Refused)
Q14C (If Q14B = NO)
Is there a particular reason why you do not want to sign up to be an organ donor? [open-ended response RECORD VERBATIM]
Q14C1 (If Q14C = “don’t know” or “no reason”)
Would you say it is for one of these reasons?
Yes
No
(Don’t Know)
(Refused)
Haven’t thought about it
I would need more information
Because of medical reasons
I feel I am too old
I don’t believe I will receive the best medical treatment if I’m a donor
I prefer to leave the choice to my family
I don’t trust putting my name on a registry
Q14D (If Q14B =YES)
Is there a particular reason why you have not signed up to be an organ donor? [open-ended response RECORD VERBATIM]
Q6A (If Q5 NOT = definitely yes or probably yes)
Is there a particular reason why you do not want your organs donated upon your death? If Yes, what might that reason be?
[open-ended response RECORD VERBATIM]
(Don’t Know)
Some Other Reason
Q6A1 (If Q6A = “don’t know” or “no reason”)
Would you say it is for one of these reasons?
Yes
No
(Don’t Know)
(Refused)
It’s against my religion
For medical reasons
I don’t want my body cut up or disfigured
Donation costs might be passed to my family
They might take my organs before death
I don’t believe I will receive the best medical treatment if I’m a donor
I feel I am too old
I don’t believe an autopsy could be performed if organs are donated
My family does not support donation
Q6B (If Q5 NOT = definitely yes or probably yes)
Have you discussed with a member of your family your wish not to donate your organs after your death?
Yes
No
(Don’t Know)
(Refused)
N/A or No Family Members
Q6BB (If Q5 NOT = definitely yes or probably yes)
Is there one thing that could change your mind to want to be a donor?
Yes [SPECIFY AND RECORD VERBATIM]
No
(Don’t Know)
(Refused)
Q6BC (If Q13 = Yes)
If you had to identify the biggest reason or reasons why you want to be an organ donor, what would those be? [Open-ended response RECORD VERBATIM]
Q6BD (If Q6BC= “don’t know” or “no reason”)
Would you say it is for one of these reasons?
Yes
No
(Don’t Know)
(Refused)
To save a life
I won’t need them any longer
It’s the right thing to do
Q6C (If Q13 = Yes)
Have you discussed your wish to be an organ donor with a member of your family?
Yes
No
(Don’t Know)
(Refused)
N/A or No Family Members
Q7 (If Q6C NOT Yes)
How willing are you to discuss your wishes about organ donation with your family? Would you say very willing, somewhat willing, not very willing, or not at all willing?
Very willing
Somewhat willing
Not very willing
Not at all willing
(Don’t Know)
(Refused)
Q8 (If Q6C = not very willing or not at all willing or (Don’t Know))
Is there a particular reason why you are unwilling to discuss donation with your family?
Yes
No
(Don’t Know)
(Refused)
Q8A (If Q8 = Yes)
What is that reason?
[SPECIFY AND RECORD VERBATIM]
(Don’t Know)
No Reason
Q8B (If Q8A = “don’t know” or “no reason”)
Would you say it is for one of these reasons? [MULTIPUNCH SELECT ALL THAT APPLY]
I don’t want to discuss death with my family
My family wouldn’t understand
My family believes the body should be buried whole
My family is too young to discuss this
I am not in good health
My donor registration is not my family’s business
Whether or not I become a donor is my family’s decision to make
Talking about death may increase the chance of dying
Someone in my family may need my organs
Q9 (If Q6B NOT N/A or No Family Members or Q6C NOT N/A or No Family Members)
Has any member of your family told you about their wish to donate or not to donate their organs after death?
Yes
No
(Don’t Know)
(Refused)
Q10 (If Q6B NOT N/A or No Family Members or Q6C NOT N/A or No Family Members)
If you didn’t know your family member’s wishes, how likely would you be to donate their organs upon their death, if it were up to you? Would you be very likely, somewhat likely, not very likely, or not at all likely?
Very likely
Somewhat likely
Not very likely
Not at all likely
(Don’t Know)
(Refused)
Q11 (If Q6B NOT N/A or No Family Members or Q6C NOT N/A or No Family Members)
a family member had told you they wanted to be an organ donor but were not signed up on the donor registry, how likely would you be to donate their organs, if it were up to you? Would you be very likely, somewhat likely, not very likely, or not at all likely?
Very likely
Somewhat likely
Not very likely
Not at all likely
(Don’t Know)
(Refused)
Q24 What percentage of adults in the US do you think are signed up as organ donors?
[0% to 100%]
Q12 Now, I am going to read you a number of statements. For each one, please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree.
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
(Don’t Know)
(Refused)
[ROTATE FOLLOWING CHOICES]
12A. It is important for a person's body to have all of its parts when it is buried.
12B. It is important for people to tell their families whether or not they would want their organs to be donated upon death.
12C. Most members of my family would support the idea of organ donation.
12D. Receiving organ transplants improve people’s lives.
12E. Organ donation allows something positive to come out of a person's death.
12F. A deceased person's next of kin should be able to override the deceased person's registration status to donate their organs.
12H. All people who need an organ transplant should be able to receive a transplant.
16A. Racial and ethnic minority patients are less likely to receive organ transplants.
16B. You are worried that a loved one's body would be disfigured if their organs were donated.
16D. People who choose to donate a family member's organs end up paying extra medical bills.
16G. If you indicate you intend to be a donor, doctors will be less likely to try to save your life.
16J. You would agree to receive an organ transplant if it would save your life.
16K. The U.S. transplant system uses a fair approach to distribute organs to patients.
22A. Given equal need, a poor person has as good a chance as a rich person of getting an organ transplant.
22B. Doctors do everything they can to save a person's life before organ donation is even considered.
22D. Organ donation is against my religion.
22E. It is impossible to have a regular funeral service following organ donation.
22F. Many people on the national transplant waiting list die because the organ they need isn’t donated in time.
22G. Too many donated organs are not transplanted.
Q14F Do you believe these statements about organ donation are true?
Yes
No
(Don’t Know)
(Refused)
Kidneys can be donated from a living donor.
Parts of livers can be donated from a living donor.
The uterus can be donated from a living donor.
Intestines can be donated from a living donor.
Q14G Have you ever donated an organ or a part of an organ?
Yes
No
(Don’t Know)
(Refused)
Q15 Assuming you are medically able, how likely would you be to donate an organ while you are living to [INSERT ROTATED CHOICES]? Would you say very likely, somewhat likely, not very likely, or not at all likely?
Very likely
Somewhat likely
Not very likely
Not at all likely
(Don’t Know)
(Refused)
A close friend
A family member
An acquaintance
Someone you don’t know
Q15A (If Q15 = not very likely or not at all likely)
What are your reasons for not agreeing to donate an organ while you are living? [Open-ended response RECORD VERBATIM]
Q25 It has been suggested that more people would consider living donation of organs like a kidney if they received some incentive to do so. This might include something like a cash payment, free health insurance, or a cash donation to a charity of their choice. Would you support using incentives like this to increase living organ donation?
Strongly support
Support
Oppose
Strongly oppose
(Don’t Know)
(Refused)
Q27 Would incentives make you more likely or less likely to be a living organ donor? What about…
A cash payment
Free health insurance
A donation to a charity of your choice
Much more likely
A little more likely
No more or less likely
A little less likely
Much less likely
Q27D. Are there other types of incentives that would make you more likely to be a living organ donor? [Free text]
Q16AA [IF Q16A= “Strongly Agree” or “Somewhat Agree” ASK Q16AA, ALL OTHERS GOTO Q16N] Why do you think racial and ethnic minority patients are less likely to receive organ transplants? [open-ended response RECORD VERBATIM]
Q16N Please choose the statement that comes closest to your view (Rotate)
If I were a donor, I would like my organs to go to the more medically urgent patients regardless of where they live in the U.S., OR
If I were a donor, I would like my organs to go to patients in my local area even if they are not the more medically urgent patients waiting for an organ.
(Don’t Know)
(Refused)
Q17 Some countries assume that people will be organ donors upon their death, unless there are strong objections from the family. This is sometimes called presumed authorization. Would you strongly support, support, oppose, or strongly oppose using this presumed consent approach in the United States?
Strongly Support
Support
Oppose
Strongly Oppose
(Don’t Know)
(Refused)
Q17A (If Q17 = “Oppose” or “Strongly oppose”)
Is there a particular reason why you oppose presumed authorization? [Open-ended response RECORD VERBATIM]
Q17C If the United States changed to a presumed authorization system, where people will be organ donors unless they opted out, would you choose to opt out?
Yes
No
(Don’t Know)
(Refused)
Q18 It has been suggested that more organs would be donated if families who donate the organs of a deceased loved one received assistance in paying funeral expenses, a cash award to the donor's estate, or a cash award to a charity of the family's choice. Would payments like these make you more likely or less likely to donate (read and rotate), or would it have no effect?
More Likely
Less Likely
No Effect
(Don’t Know)
(Refused)
Your own organs
A family member’s organs at their time of death
Q19 (If Q18A or Q18B = more likely)
Is there a particular reason why a payment would make you more likely to donate your organs or a family member's organs?
Yes
No
(Don’t Know)
(Refused)
Q19A (If Q19= Yes)
What reason? [Open-ended response RECORD VERBATIM]
Q20 (If Q18A or Q18B = less likely)
Is there a particular reason why a payment would make you less likely to donate your organs or a family member's organs?
Yes
No
(Don’t Know)
(Refused)
Q20A (If Q20= Yes)
What reason? [Open-ended response RECORD VERBATIM]
D1 What sex were you assigned at birth, on your original birth certificate?
Female
Male
(Don’t Know)
(Refused)
D16. How do you currently describe yourself?
Female
Male
Transgender
I use a different term [free text]
(Don’t Know)
(Refused)
Q15E Medical breakthroughs have resulted in new types of transplants, such as hands, face, larynx, and uterus, for those who may have lost theirs through traumatic injury or illness. How willing would you be [INSERT ROTATED CHOICES]? Would you say you are very willing, somewhat willing, not very willing, or not at all willing?
Very Willing
Somewhat Willing
Not Very Willing
Not at all Willing
(Don’t Know)
(Refused)
Upon your death to donate your…
Q15E1 If your family member signed up to be an organ donor, upon their death will you also be willing to [INSERT ROTATED CHOICES]? Would you be very willing, somewhat willing, not very willing, or not at all willing?
Very Willing
Somewhat Willing
Not Very Willing
Not at all Willing
(Don’t Know)
(Refused)
Q23A Has anyone close to you ever donated an organ or tissues, either while living or after death?
Yes
No
(Don’t Know)
(Refused)
Q23B Have you, or has anyone close to you, ever received an organ transplant?
Yes
No
(Don’t Know)
(Refused)
Q23C Have you, or has anyone close to you, ever been on a transplant waiting list?
Yes
No
(Don’t Know)
(Refused)
Q26A Do you believe there is an age when someone is too old to donate an organ upon their death?
Yes
No
(Don’t Know)
(Refused)
Q26A2 (If Q26A = Yes)
What is that age? [RECORD NUMERIC]
Q26B Do you believe there is an age when someone is too old to receive an organ?
Yes
No
(Don’t Know)
(Refused)
Q26B2 (If Q26B = Yes)
What is that age? [RECORD NUMERIC]
Q28 In general, how would you rate your overall health? Would you say excellent, very good, good, fair, poor?
Excellent
Very Good
Good
Fair
Poor
(Don’t Know)
(Refused)
Q36 Have you ever been vaccinated for COVID-19, even just once?
Q29 What best describes your religion, if any? Would you say Protestant, Evangelical, Roman Catholic, Orthodox, Mormon, Jewish, Muslim, Buddhist, atheist, agnostic, or something else?
Protestant
Roman Catholic
Mormon (Church of Jesus Christ of Latter-day Saints/LDS)
Orthodox (Greek, Russian, or some other Orthodox church)
Jewish (Judaism)
Muslim (Islam)
Buddhist
Hindu
Atheist (do not believe in God)
Agnostic (not sure if there is a God)
nothing in particular
(Don’t Know)
(Refused)
Q30 How important are your religious beliefs?
Very Important
Somewhat Important
Not Very Important
Not at all important
(Don’t Know)
(Refused)
Q32. How much of the time do you think you can trust the health care system to do what is right for you?
Almost all of the time
Most of the time
Some of the time
Almost none of the time
(Don’t Know)
(Refused)
Q33. In general, would you say the organ transplant system in the US is headed in the right direction, or is it on the wrong track?
Right direction
Wrong track
Somewhere in between
Don’t have an opinion or don’t have enough information
(Don’t Know)
(Refused)
Q33A
Why do you feel that way? [Open-ended response RECORD VERBATIM]
D2 What is your age? [RECORD NUMERIC]
D3 What is the highest level of education you have completed? [READ CHOICES]
less than high school graduate
high school graduate
some college
trade/technical/vocational training
college graduate
post-graduate work/degree
(Don’t Know)
(Refused)
D4A What is your current marital status?
single/never been married
married
separated
divorced
widowed
domestic partnership/living with partner (not legally married)
(Don’t Know)
D8 What is your zip code?
[RECORD 5 DIGIT NUMERIC]
(Don’t Know)
(Refused)
D11 What best describes your race and/or ethnicity? (can select more than one option)
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
(Don’t Know)
(Refused)
D11_1 (If D11 equals 1)
What American Indian or Alaska Native origin specifically? [open text]
(If needed: “For example, Navajo Nation, Blackfeet Tribe, Barrow Inupiat, Nome Eskimo, Aztec, Maya, etc.”)
D11_2 (If D11 equals 2)
What Asian origin specifically?
Chinese
Asian Indian
Filipino
Vietnamese
Korean
Japanese
Something else [open text]
(Don’t Know)
(Refused)
D11_3 (If D11 equals 3)
What Black or African American origin specifically?
African American
Jamaican
Haitian
Nigerian
Ethiopian
Somali
Something else [open text]
(Don’t Know)
(Refused)
D11_4 (If D11 equals 4)
What Hispanic or Latino origin specifically?
Mexican
Puerto Rican
Salvadoran
Cuban
Dominican
Guatemalan
Something else [open text]
(Don’t Know)
(Refused)
D11_5 (If D11 equals 5)
What Middle Eastern or North African origin specifically?
Lebanese
Iranian
Egyptian
Syrian
Iraqi
Israeli
Something else [open text]
(Don’t Know)
(Refused)
D11_6 (If D11 equals 6)
What Native Hawaiian or Pacific Islander origin specifically?
Native Hawaiian
Samoan
Chamorro
Tongan
Fijian
Marshallese
Something else [open text]
(Don’t Know)
(Refused)
D11_7 (If D11 equals 7)
What White origin specifically?
English
German
Irish
Italian
Polish
Scottish
Something else [open text]
(Don’t Know)
(Refused)
D13 What best describes your current employment status? [READ CHOICES]
Employed full-time
Employed part-time
Taking care of home or family but not working for pay
Not employed but looking for work
Student
Retired
Unable to work
Other
(Don’t Know)
(Refused)
D18 Have you ever served in the US Uniformed Services?
[If clarification needed: This includes the Army, Navy, Marine Corps, Air Force, Space Force, Coast Guard, Public Health Service Commissioned Corps, and Commissioned Corps of the National Oceanic and Atmospheric Administration.]
Yes
No
(Don’t Know)
(Refused)
D19 For how many years of your life have you lived in the United States?
My whole life
________ years
(Don’t Know)
(Refused)
D14 Do you currently have any type of health insurance plan or health coverage?
Yes
No
(Don’t Know)
(Refused)
D15 (If D14 = Yes)
What best describes the source of your health plan? If you have more than one, please select your primary plan. [READ CHOICES]
Private plan, such as through an employer
The federal insurance exchange at healthcare.gov, or a state insurance plan
Medicaid
Medicare
Veterans’ Affairs
TRICARE/Military Health System
Other government or state plan
Other
(Don’t Know)
(Refused)
D21 How many people, including yourself, live in your household?
D9 What is your total ANNUAL household income, before taxes? Please include income from wages and salaries, remittances from family members living elsewhere, farming, and all other sources. Please say “yes” when we reach your annual household income.
[READ CHOICES]
Less than $20,000,
$20,000 or more, but less than $30,000
$30,000 or more, but less than $40,000
$50,000 or more but less than $60,000
$60,000 or more, but less than $75,000
$75,000 or more but less than $100,000
$100,000 or more, but less than $150,000
$150,000 or more
(Don’t Know)
(Refused)
D22 When it comes to social and political issues, how would you describe yourself?
Conservative
Moderate, conservative-leaning
Moderate but varies depending on the issues
Moderate, liberal-leaning
Liberal
Other
(Don’t Know)
(Refused)
Thank you for your participation. Results of the survey will be available in about six months on a government website at www.organdonor.gov.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | NSODAP Revised Survey Jan28_deleted text removed |
Author | Chris Duke |
File Modified | 0000-00-00 |
File Created | 2024-11-15 |