: This study will examine the degree to which environmental and organizational factors influence the change in the number of potential organ donors and the actual-to-potential donor conversion rate in hospitals over time. This study seeks to identify the reasons that hospitals differ in their organ donor potential and their donor conversion rate. Institutional theory is the organizational theory that will guide the research. The conceptual model proposes that a hospital's number of potential donors as well as its donor conversion rate is a function of 3 institutional forces within the hospital's environment: coercive, mimetic, and normative forces. The model proposes that each of these forces can be operationalized using hospital-level, organ procurement organization level, and donor service area-level variables. The study will be a 4-year longitudinal panel design and will be conducted using five large secondary databases: The Health Care Cost and Utilization Project's Statewide Inpatient Discharge database; the United Network for Organ Sharing database; the American Hospital Association database; the Area Resource File; and the Joint Commission on Accreditation of Healthcare Organizations. The analysis will be conducted using a structural equation modeling approach. Confirmatory factor analysis will be applied to measure the suitability of each of the variables chosen as indicators for the three theoretical constructs of institutional theory. Latent growth curve analysis will be employed to determine how growth rates of potential donors and donor conversion rates over time differ for different types of hospitals as well as how institutional factors influence these growth rates. This study will contribute to a very limited body of empirical research examining factors affecting organ donation at the hospital level. It will inform policy makers of the most important influences on hospitals' potential donor pools and donor conversion rates so that future legislative initiatives designed to increase the number of U.S. organ donors could target hospitals that are most capable of responding to them.
