Gayle Graves-Besosa is an organ donor. Like 2.5 million other Virginians, she indicates her choice on her driver's license.
But her story goes a step further. In 1989, she lost her son Josh Graves, 12, in a fatal car crash. By sharing with high school students the story of her own son's organ donation, Graves-Besosa facilitates a year 2000 state mandate that requires schools in Virginia to teach organ donation in driver's education class.
Virginia is one of a handful of states that use driver's education as a vehicle to boost donations, a relatively new tactic according to organ donation experts.
Organ donation saves thousands of lives each year. Nearly 25,000 transplants were completed in 2002. But the national list for patients waiting for organs tops 82,000 and a new name is added every 13 minutes, according to the United Network for Organ Sharing (UNOS), a national non-profit organization based in Richmond, Va. "This is a key opportunity for states to educate young people who are getting their (driver's) licenses that this option exists, that this is the time to take advantage of it and that they could play a very critical role in helping to save others' lives," said Trudi Matthews, chief health policy analyst with The Council of State Governments.
Over the past six months, Graves-Besosa made eight trips to Amelia High School in Amelia Co., Va., sharing her family's experience with more than 200 driver's education students.
"We had talked about (organ donation) as a family prior to the accident and that's what actually made it okay for us because we knew what he wanted. We talked about it never knowing of course that it would happen," Graves-Besosa told Stateline.org. But 14 years later, she said she thinks teaching about organ donation keeps her son's memory alive and helps young people understand the magnitude of the decision.
Josh donated his heart, liver, kidneys and cornea. One of the kidney recipients was a 15-year-old girl.
"This is a very impressionable age, probably more so than anyone would realize ... You could really see them get serious and really think, I can make some decisions on my own. This is a decision I need to think about,'" Graves-Besosa said.
There is no definitive count of states that require organ donation to be taught in driver's education, but according to state and federal officials at least eight others Arkansas, Indiana, Iowa, Minnesota, Mississippi, Ohio, Texas and Wisconsin have adopted similar policies in the past few years.
Other states, such as North Carolina, require organ donation to be taught in other disciplines such as health or physical education classes. Other organ donation advocates and state government officials said driver's education is an effective forum to educate young people about donation myths and statistics.
Arkansas passed legislation in March 2003 that became effective July 16 requiring organ donation to be included in the state driver's education manual. The state now also requires organ donation to be taught in post-secondary health education, said Boyd Ward, executive director of ARORA, the Arkansas Regional Organ Recovery Agency, an organ procurement organization (OPO) that lobbied for the legislation.
Organ procurement organizations are private, non-profit organizations that oversee the retrieval of organs for transplantation.
Minnesota passed a 2002 law mandating that organ donation be included in driver's education. The state has since seen a 26 percent jump in donor intent on driver's licenses, according to Susan Larson, spokeswoman for LifeSource, a regional OPO. Though this can't be directly attributed to the driver's education program, advocates said they believe it's a factor.
Wisconsin was the first state to require discussions about organ donation in driver's education classes. In May 2000, then-Gov. Tommy Thompson signed "Kelly's Law," which requires that all driver's education courses offered in the state provide at least 30 minutes of instruction relating to organ and tissue donation.
Kelly's Law is named after Kelly Nachreiner, an 18-year-old woman killed in a car crash just weeks after signing the back of her driver's license to become a donor.
In April 2001, after Thompson moved to Washington, D.C., to assume leadership of the U.S. Department of Health and Human Services (HHS), the secretary laid out the "Gift of Life" initiative to promote organ donation nationwide. As part of the initiative, HHS created a model curriculum for driver's education and other classes for state and local school systems and outreach organizations to adopt.
The department expects to unveil the plan in the next few months, said Joy Demas, a public health analyst in the federal government's Division of Transplantation under HHS's Health Resources Services and Administration (HRSA). HHS will provide educational materials on organ donation, including a CD-Rom and a video cassette geared to students grades nine to 12, Demas said.
"The (secretary's) idea of having a donation education program for secondary students came out of the legislation that he supported in Wisconsin," Demas told Stateline.org.
So why isn't every state jumping to require organ donation in driver's ed?
"In terms of driver's education curriculum, there is a reluctance to add one more requirement to the educational process or to add additional requirements on schools ... But there is also a recognition that this is a critical time when kids are getting their licenses," CSG's Matthews said.
In addition, states are trying to boost donation by creating organ donor registries databases commonly run by the Department of Motor Vehicles that track those who have consented to donate their organs by signing their driver's license.
For example, former Massachusetts Gov. Jane Swift (D) signed a registry into law in January 2003, just days before she left office. There is no national organ donor registry, but more than 23 states are developing or have established registries, according to United Network for Organ Sharing data.
Several states also have passed laws allowing state employees to take paid leaves of absence to donate organs or bone marrow.
Despite these steps, state-level legislative activity on organ donation isn't booming in 2003, one policy analyst said.
"I think in this difficult budget environment some of those activities have been more difficult to find funding for. But prior to the states having budget difficulties there was just a whole lot of activity going on having to do with organ donation," CSG's Matthews said.
Virginia, for instance, cut funding for the state agency on organ donation the Virginia Transplant Council. The agency now exists only on paper and is run by a Virginia OPO.