Nearly six out of 10 Iowans have a small notation at the lower-right corner of their driver’s license that identifies them as an organ donor. Fantastic, right?

Wrong. To actually become an eligible organ donor, prospective donors must also register with Iowa Donor Network. Only a fraction of those people, a little more than 47,000, have taken that second step.Last year, organs were recovered from just 72 Iowans who were designated as donors or had their families consent to donation when they died.

To move more people from the good-intention stage into action, Iowa Donor Network plans to expand its reminder card program for those prospective donors. It also hopes to launch an automated system later this year in which checking “yes” at the driver’s license station will initiate the donor registration process. Utah, which adopted automatic registration in 2002, now has more than half of its 2.7 million residents registered as donors.

It’s one of several innovations the not-for-profit organization will make to streamline its processes and shrink the waiting lists of people needing organ transplants in Iowa.

As improved medical procedures allow more and more organs to be successfully transplanted, the demand for organ transplants continues to rise. More than 90,000 people nationally are on waiting lists for organs, with the vast majority of those patients, nearly 65,000, waiting to receive a kidney.

“In the past year, we’ve almost doubled our waiting list, especially for kidney transplants,” said Liana Frost, transplant coordinator at Mercy Medical Center in Des Moines, which with Iowa Methodist Medical Center is one of four transplant centers in Iowa. “The waiting time can be anywhere from one to three years, so we always look for living donors first,” she said. “If that’s not available, then we put them on the waiting lists.”

In Iowa, 361 people were on waiting lists as of early February. That number has actually declined for the first time in recent months, as the transplant centers have adopted more successful procedures for approaching donors’ families and worked to increase the number of organs received per donor.

At Mercy, as at each of the transplant centers, physicians and nurses now use a “trigger card” that prompts them to notify Iowa Donor Network when a patient appears likely to die or become brain dead. The medical staff also has “team huddles” to discuss how best to approach the family. Additionally, the staff “decouples” the news that the family member is brain dead from the suggestion that the family consider organ donation.

Using these procedures, Mercy in the past six months has nearly doubled its donor-completion rate, the percentage of potential donors who actually donated organs, from 42 percent to about 75 percent, Frost said.

“It used to be that the hospitals would view organ donations as, ‘That’s Iowa Donor Network’s responsibility,’ she said. “Now we see that it’s something that’s good for us.”

In addition to finding more donors, donor networks across the country are also working to increase the number of organs received from each donor, said Paul Sodders, public information manager for the Iowa Donor Network.

Under a nationwide initiative that began in October, the average number of organs received per Iowa donor has increased from three to five, which gives the state the highest average in the nation, he said.

“That’s exciting for us, because we always thought we were doing a good job, and now we know we can do even better,” Sodders said.

Overcoming misperceptions about organ donation is one of the biggest hurdles to increasing participation rates, he said.

“The big one that we consistently hear is that people are afraid that organ donation is going to cost their family money,” he said. “They want to know, ‘Who is going to pick up the cost of the donation surgery, picking up the organs and shipping them?’ We do.”

Medicare reimburses Iowa Donor Network and the hospitals for the costs related to recovering and transporting kidneys for transplant, “because Medicare figured out that it’s actually cheaper to transplant patients rather than keep them on dialysis for years and years,” Sodders said. “For the other organs, we have an acquisition charge the transplant centers will give us for carrying the organs and sending them out for transplant.”

Because IDN’s funding varies according to the level of organ donations reached each year, having enough money to pay for outreach efforts is always a battle, he said.

“So if we have a lower year where we don’t have as many organ donors, then by mid-year we’re cutting out a lot of the extra public education stuff we’ve been able to offer.”

As part of a national initiative to reduce recipient waiting lists, Iowa Donor Network is getting ready to introduce a program to address a problem that often arises in live kidney transplants.

“A lot of times, people who need a kidney can get a living donation from someone they know, but sometimes they don’t match, but they may match someone else,” Sodders said. “So if donor A has a recipient that doesn’t match them, but there’s someone else in the state that would match them, we can cross-match these couples so they can donate to each other. This has been done once at [Iowa] Methodist, but we’re going to take this statewide.” Each transplant center will track possible paired exchanges using a Web-based system.

“We’re hoping this is going to make a huge difference in our kidney donation list,” Sodders said. There are a lot of people out there with someone willing to donate to them, but they just don’t match. So we’re going to try to identify those folks.”

Along with these changes in organ donation procedures, one of the biggest is yet to come.

“Starting in 2007, we’re going to change the way that we actually offer organs to recipients and their surgeons for transplant,” Sodders said. Under the current system, IDN’s nurses must call each physician who has a potential organ recipient, based on his or her priority on the national registry, to determine if the patient is in suitable condition to accept the organ.

Under the new system, which will go into effect nationally, “rather than us running that list and having to call multiple centers until someone accepts that organ for transplant, it will all go out electronically, so the surgeons will get those offers real-time and be able to accept or decline immediately, which is going to make the process a lot faster,” he said.

Currently, it’s not uncommon for an Iowa Donor Network staff member to spend up to 12 hours on the phone in the process of trying to find suitable recipient, Sodders said.

“It’s a race against the clock,” he said. “Usually when a (donor) becomes brain dead, it takes a while before their organs start shutting down, but the deterioration does start. The quicker you can get the organs placed, the better off the recipient will be in the end. We don’t think we’ve missed any (potential donations due to delays), but we just think the outcomes will be better and quicker.”