Clinical Partner Outreach Survey

Dear Donate Life America Community Partners,

Our goal is to take feedback from those in the clinical field to identify the needs of Donate Life Community clinical partners in promoting living and deceased donation. Additionally, we are working to develop resources and educational materials regarding birth tissue. We would like to survey you for your input on best practices and suggestions.

This survey has three sections. Section One is based on needs around deceased donation, Section Two will ask for feedback on living organ donation and Section Three will focus on birth tissue donation.

All those who complete a survey will be entered to win one of several prizes. For questions about Donate Life America or this survey, please contact Karen Headley.

This survey closes at 11:59pm on June 30, 2023. Thank you for your participation.

State *

In what clinical setting do you work? *

Organization Name

What is your position within your organization? *

How familiar are you with Donate Life America? *

Very Familiar

Somewhat Familiar

Not Familiar

What aspects about Donate Life America are you familiar with?

Is your organization involved with your Donate Life State Team? *

Yes

No

Not Sure

What is a Donate Life State Team?

Which Donate Life State Team? *

Are you interested in learning more about or partnering with your Donate Life State Team? If yes, please be sure to provide your contact information at the end of this survey.

Yes

No

Not Sure

Does your organization celebrate any of the following Donate Life observances (check all that apply)? *

National Donor Day (February 14)

National Donate Life Month (April)

Donate Life Living Donor Day (April)

National Minority Donor Awareness Month (August)

None of the above

Other Other

If you celebrate a Donate Life observance, please provide examples of your organization's activities (e.g. Donate Life flag raising, donor drives, etc). *

How familiar are you with this symbol being the symbol for the cause of organ, eye and tissue donation?

*

I am not familiar with the Donate Life symbol

I have seen it before, but I thought it was the organ recovery agency's logo

I know it, and trust it as a symbol for the cause, but we don't use it in our donation promotion initiatives

I know it and my organization incorporates it into all of our donation promotion activities

Other Other

Section One: Deceased Donation

What is your level of involvement with deceased organ, eye and tissue donation? *

Very Involved

Slightly Involved

Rarely Involved

Not Involved

Please give more information on your involvement with deceased donation.

Do you actively educate about deceased donation? *

Yes

No

Does your organization include a call to register as a deceased organ, eye and tissue donor (check all that apply)? *

Yes, on our website

Yes, with patient stories

Yes, on social media

No, we do not include a call to register

If not, why?

What do you think are the most important message points when speaking about deceased donation? *

What questions do you receive about deceased donation?

What educational vehicles do you find most effective to use when discussing deceased donation (check all that apply)? *

Who do you find is the most influential as a spokesperson to deliver messages about deceased donation? *

What are resources that you use to promote deceased donation that you would like to share with others?

If you have resources to share, please upload them here.

What resources could Donate Life America and/or your Donate Life State Team offer to help you promote deceased donation? *

Section Two: Living Organ Donation

What level of involvement do you have with living organ donation? *

Very Involved

Slightly Involved

Rarely Involved

Not Involved

Please give more information on your involvement with living organ donation.

What do you think are the most important message points when speaking about living organ donation? *

What questions do you receive about living organ donation?

What educational vehicles do you find most effective to use when educating about living organ donation (check all that apply)? *

Who do you find is the most influential as a spokesperson to deliver messages about living organ donation? *

What are resources that you use to promote living donation that you would like to share with others?

If you have resources to share, please upload them here.

What resources could Donate Life America and/or your Donate Life State Team offer to help you promote living organ donation? *

Section Three: Birth Tissue

Do you consider birth tissue a part of living donation? *

Yes

No

If no, why not? *

What level of involvement do you have with birth tissue donation? *

Very Involved

Slightly Involved

Rarely Involved

Not Involved

Please give more information on your involvement with birth tissue donation.

What do you think are the most important message points when speaking about birth tissue? *

What questions do you receive about birth tissue donation?

How do you refer to birth tissue? What words do you use to describe birth tissue to the public? *

What resources would help you in educating about living birth tissue (check all that apply)? *

Who do you find is the most influential as a spokesperson to deliver messages about birth tissue donation? *

What are resources that you use to promote birth tissue donation that you would like to share with others?

If you have resources to share, please upload them here.

What resources could Donate Life America and/or your Donate Life State Team offer to help you promote birth tissue donation? *

Contact Information to Be Entered for Prizes

If you are interested in being entered for one of five $50 Amazon gift cards, please provide ALL of the below requested contact information:

First Name

Last Name

Title

Organization Name

Phone Number

Email Address

Thank you for sharing your thoughts with us!