Taking advantage of college students' frequent use of online technology, including social networking sites (e.g., Instagram a social media site /Facebook a social networking site) and social media sites (e.g., YouTube), the investigators will create an online intervention that leverages this technology to engage and educate Asian, Native Hawaiian, Pacific Islanders (ANHPI)students about a range of topics related to organ donation following death.

Over 56% of the 120,000 critically ill Americans waiting on transplant waiting lists are ethnic minorities. The proportion of ethnic minorities, including Asian, Native Hawaiian, Pacific Islanders (ANHPI), on waiting lists exceeds their representation in the general population. However, few ANHPI adults are designated organ donors (DOD) on their driver's licenses or in a donor registry. ANHPI college students (aged 18-29) also have low DOD rates, particularly Filipinos. Individuals are typically asked about becoming a DOD when renewing a driver's license; but most never think about OD outside of the short-lived Department of Motor Vehicles (DMV) transaction. Knowing someone's status as a DOD on their license can be an influential factor in solidifying a family's feelings about donating a relative's organs after his/her death, if their consent is necessary. Of those who choose DOD status on a license, most will remain one for life. Intervening with drivers before the date of their license renewal can be difficult to arrange; however, opportunities arise when college students turn 21 and want to renew their license in order to remove formatting / colors signifying that the license belongs to an underage minor (< 21 years old).

Taking advantage of college students' frequent use of online technology, including social networking sites (e.g., Instagram a social media site /Facebook a social networking site) and social media sites (e.g., YouTube), the investigators created an online intervention that leveraged this technology to engage and educate ANHPI students about a range of topics related to organ donation (OD). It will also provide culturally sensitive messages tailored to their interest in or wariness of organ donation and reframe students' attitudes about OD and becoming a DOD. Previous internet interventions to encourage college students to become DODs have not included culturally sensitive approaches for ANHPI, who have unique barriers to OD. The cross-sectional design will test the impact of introducing, sequentially, an online intervention tailored to college students at three universities (UH-Manoa, UH-Hilo, and Hawaii Pacific University). The sequence of when the a university received the intervention was randomly determined; thus, the study's design was a cross-sectional design. The goal was to increase DOD rates in college students, particularly ANHPI and encouraging peer discussions/interactions/advocacy about OD.

Effectiveness will be measured by a change over time in the percentage of students who report being a DOD on their license/donor registry (250 students per university measured across 6 time points; thus, the total sample = 4,500). The investigators anticipate a 12% increase in DOD rate in students who are exposed to the intervention. Increases in DOD status will also be tracked via an increase (over normal rates) in the number of new donors aged 18-29 who register as a donor on Hawaii's online donor registry. To make the study website relevant to college students the investigators will include resources useful for assignments in courses (e.g., both in required "general education" courses- including one on "writing skills", and courses on ethics, religion, sociology, and culture/ ethnic studies, etc.) Students and student organizations will participate in contests to win prizes (e.g., for the best 1-minute DOD focused-YouTube video/ Instagram picture, creating a "caption" for a photo on Instagram, and student organizations who compete for group awards). A goal of the intervention will be to reframe OD by engaging altruistic attitudes based on college students' commitment to "green" sustainability efforts (e.g., "go green, recycle yourself"). Innovative culturally sensitive strategies that can engage, educate, and reframe DOD for college students, including those who find it unappealing (i.e., the "ick factor") are clearly needed. The online intervention will saturate online venues (i.e., YouTube, Instagram) visited frequently by college students, and the investigators will use the new concept of "gamification" to turn college students' learning and advocacy ideas surrounding OD/DOD into a game or contest with their peers. This project builds upon Drs. Albright and Feeley's (consultant - Univ. of Buffalo, Dept. of Communications) previous work to encourage adolescents and young adults to become a DOD; thus, the investigators feel well-suited to design, implement, and evaluate the proposed project. The intervention will increase DOD rates in ANHPI students, and thus, increase the number of ethnic minorities who become deceased organ donors now and for years to come.

Inclusion Criteria:

• Must be registered undergraduate student at University of Hawaii at Manoa, University of Hawaii at Hilo, or Hawaii Pacific University
• Must be over the age of 18yrs

Exclusion Criteria:

• Not an undergraduate college student at one of the participating university sites

We collected cross-sectional surveys at all timespoints in this study. When we conducted the first survey at each site we labeled it a "Baseline survey". Recruitment was university-wide for all online surveys. One site(UHM) had only one baseline, while the other two sites had multiple baseline surveys before their intervention started(UHH and HPU). However, demographics are reported for ALL surveys across all time pointt to provide demographics for our total survey samples (see study design)

up to 18 months for site 1 (UHM) , up to 12 months for sites 2 and 3 (HPU & UHH) (the two time periods represent entire study period for the three sites)

CTCAE

Students did not know the schedule for rolling out the intervention by university.