Q1. What is your race? *
 (Select the option that best describes you.)
 Question Type: Multiple Choice (Single-select)

  • Black or African American
  • White or Caucasian 
  • Asian
  • Native Hawaiian or Other Pacific Islander
  • Indigenous / Native American or Alaska Native 
  • Multiracial, including Black or African American
  • Multiracial, not including Black or African American 
  • Another race (please specify): ___________ 
  • Prefer not to say 

Q2. What is your age range?  *
Question Type: Multiple Choice — Single Select

  • Under 18 
  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65 or older
  • Prefer not to say

Q3. In which US State or Territory do you live? (Dropdown list of 50 states & the territories)

SECTION 2: Knowledge & Donor Status

Q4. What are the first 3 numbers of your Zip Code? ____ 

Q4. How would you rate your knowledge of organ donation and transplantation?

Question Type: 5-Point Likert Item

  • 1- Very low – I know almost nothing about it
  • 2- Low – I know a little, but not much
  • 3- Moderate – I know some basic facts
  • 4- High – I know quite a bit
  • 5- Very high – I am very familiar with the process and details

Q5.  To the best of your knowledge, which of the following are valid ways someone can register as an organ donor? Select all that apply or choose ‘I’m not sure.’  

Question Type: Multiple Choice — Multi Select

  • State’s donor registry online
  • At a local motor vehicle agency (DMV)
  • Through a medical provider (e.g., at a hospital or doctor’s office)
  • I’m not sure / don’t know

Q6. Please indicate whether you believe each of the following statements is true or false.

Question Type: 1) True 2) False 3) I’m not sure / don’t know

  • Organ donation has no financial cost to me or my family
  • Organs from donors of any race can be transplanted into recipients of any race
  • Organs from Black donors are more likely to match/ be compatible with Black recipients
  • Organ donation would prevent me from having an open-casket funeral 
  • Organ donation saves lives

Q7. Please indicate how much you agree or disagree with the following statements on organ donation and transplantation

Question Type – 5 point likert scale (Matrix)

1 – Strongly Disagree

2 – Disagree

3 – Neither Agree nor Disagree

4 – Agree

5 – Strongly Agree

N/A option

  • I don’t trust the medical system
  • I worry doctors won’t try to save me if I’m a donor
  • I don’t have enough information about organ donation
  • It’s against my culture, religion, or spiritual beliefs
  • I believe there is a black market for organs in the US
  • I believe Black patients receive the same access to transplant evaluations and waitlist placement as other patients.
  • I do not believe Black patients are treated with the same respect and dignity as other patients throughout the transplant process.
  • The rich or famous are more likely to get a transplant
  • To confirm you are reading the statements carefully, please select ‘Agree’ for this item

Q8. Which of the following best describes your current organ donor registration status?
 (Select one)

Question Type: Multiple choice

  • I have indicated I’m a donor (for example, on my driver’s license, state ID, or an online registry) → Go to Section 3: For Registered Donors
  • I am not registered, but would like to learn more → Go to Section 4: For Non-Donors
  • I am not registered and do not plan to register → Go to Section 4: For Non-Donors
  • I was registered, but I am not anymore → Go to Section 4: For Non-Donors
  • I’m not sure if I’m registered → Go to Section 5: Trust & Experience
  • Prefer not to answer → Go to Section 5: Trust & Experience

SECTION 3: For Registered Donors

Q9. What influenced your decision to register as an organ donor? (Select all that apply)
Question Type: Multiple Choice — Multi-Select

  • I received information about organ donation efforts from a news article, public service announcement, or brochure 
  • A family member, partner, or friend registered and persuaded me 
  • A family member, partner, or friend needed an organ transplant
  • My culture, faith, or spirituality supports organ donation
  • I was prompted when applying for or renewing my driver’s license or state ID
  • A healthcare professional discussed organ donation with me
  • Other (please specify): __________

SECTION 4: For Non-Donors 

Q10. Which of the following would make you more likely to register as an organ donor?
 (Select all that apply)

Question Type: Multiple Choice — Multi-Select

  • Seeing more information featuring Black donors or recipients
  • Hearing more Black community members talk about the importance of donation
  • Learning that a family member or friend needed a transplant
  • Receiving information from someone I trust (e.g., a healthcare provider, community leader, faith or spiritual leader)
  • Hearing a personal story that resonated with me
  • Framing donation as directly benefiting Black communities
  • Having clear, simple instructions on how to register
  • Having more time to consider my decision
  • If someone directly (e.g., DMV staff, healthcare professional, donation or awareness campaign) asked me to register
  • Other (please specify): __________
  • None of these would make me more likely to register

SECTION 5: Beliefs & Trust

Q11. For each of the following, please indicate how much you trust these entities in medical settings

Question Type: 3 point Likert Scale

Scale: 1 = No trust | 2 = Moderate trust | 3 = Complete trust |  0 = Not applicable 

  • Healthcare professionals (e.g. doctors, nurses, paramedics)
  • Transplant coordinators or social workers
  • Hospitals and clinics
  • Federal and state health agencies 
  • Organ donation and procurement organizations (e.g., UNOS, Donate Life, LifeSource)


Q12. Do you personally know anyone who has been on an organ transplant waitlist or has received an organ transplant? 

Question Type: Multiple Choice — Single Select

  • Yes → Show Q13 
  • No → Skip to Q14
  • I’m not sure → Skip to Q14
  • Prefer not to answer

Q13. Which type(s) of organ were involved? (Select all that apply)

Question Type: Multiple Choice — Multi-Select

  • Kidney
  • Liver
  • Heart
  • Lung
  • Pancreas
  • Cornea (eye)
  • Bone marrow or stem cell 
  • Tissue (e.g., skin, heart valves)
  • Intestines
  • I’m not sure
  • Other (please specify): __________

SECTION 6: Messaging 

Q14. From which sources do you get most of your health information?
 (Select up to three)
Question Type: Multiple Choice — Multi-Select

  • Healthcare professionals (e.g., doctors, nurses, pharmacists)
  • Family members or friends
  • Faith or community leaders
  • Social media platforms (e.g., Facebook, Instagram, TikTok)
  • Books, Encyclopedias, Academic Journals
  • Traditional news media (TV, radio, newspapers)
  • Online health websites (e.g., WebMD, Mayo Clinic)
  • Other (please specify): __________
  • Prefer not to say

SECTION 7: Demographics

Q15. What is your gender identity?

Question Type: Multiple Choice — Single-Select

  • Woman
  • Man
  • Transgender woman
  • Transgender man
  • Non-binary, genderqueer, or gender nonconforming
  • Prefer to self-describe: __________
  • Prefer not to say

Q16. Which of the following best describes your ethnicity? (Check as many as apply): 

Question Type: Multiple Choice — Multi-Select

  • African 
  • Caribbean 
  • Afro-Latina 
  • Black/African American 
  • Multi Ethnic/ Multi Racial 
  • Other (please describe): ______
  • Prefer not to say

Q17. What are the first 3 numbers of your ZIP code?* ____

Q18. Which of the following best describes your total annual household income before taxes? (Select one)

Question Type: Multiple Choice — Single-Select

  • Less than $25,000
  • $25,000 to $34,999
  • $35,000 to $49,999
  • $50,000 to $74,999
  • $75,000 to $99,999
  • $100,000 to $149,999
  • $150,000 to $199,999
  • $200,000 or more  
  • Prefer not to say

Q19. What is the highest level of education you have completed?

(Select one)

Question Type: Multiple Choice — Single-Select

  • Less than a high school graduate
  • High school diploma or GED
  • Vocational, technical, or trade certificate
  • Some college or associate degree
  • Bachelor’s degree
  • Postgraduate or professional degree (e.g., master’s, PhD, JD, MD)
  • Prefer not to say

SECTION 8: Final Thoughts + Follow-Up

Q20. If you could ask a healthcare provider or someone who has received an organ transplant one question about organ donation, who and what would you ask?

(Please say which individual you would ask and what question you would ask them.)

Question Type: Short Answer