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Problem Solved: How A Tattoo Made Organ Donation Easy


The team at McCann Paris and McCann Germany share how tattoos encouraged people to ‘opt-in’ to organ donation in Germany, writes LBB’s Nisna Mahtani

Problem Solved: How A Tattoo Made Organ Donation Easy

Over 10,000 Germans require an organ transplant each year, however, the lack of donors means that three people die each day without receiving one. With one of the lowest organ donation rates in Europe, and the ‘opt-out’ legislation yet to be changed, Germans have to consciously ‘opt-in’ to donate. To tackle the issue, organ donation awareness organisation Junge Helde and agency McCann, across both Germany and Paris, decided to do something about the lack of donors and created ‘#OPTINK’ as a means to an end.

One in four Germans have a tattoo. So, the teams decided to create a tattoo design that works as an ‘opt-in’ and gives people a chance to save lives. Working with Berlin-based tattoo artist Gara, a minimal geometric design was created, representing an individual’s willingness to be a donor – as the current law requires individuals to show explicit proof of consent (in any form) to become donors. Launched at Junge Helden’s 20th-anniversary event, the campaign arrived on the heels of the third anniversary of the German parliament’s rejection of a bill to change donor policy from ‘opt-in’ to ‘opt-out’, which would make everyone donor by default.

Speaking with LBB’s Nisna Mahtani about the campaign is McCann Paris associate creative director Farah El Feghali, who explains how they created the design of the tattoo and rolled it out to give people a chance to save a life. 



#OPTINK is a free tattoo that allows people ‘opt-in’ for organ donation in Germany - and potentially other countries - where the law still requires explicit proof of consent to become a donor. Proof that can take any shape or form.
Designed by internationally acclaimed tattoo artist Gara (Berlin, NYC, Seoul) together with McCann Worldgroup (Paris & Germany), the organ donation awareness non-profit Junge Helden and medical staff, OPTINK’s minimal geometric forms make it unmissable, universal, scalable, and modular enough to be reinterpreted by other artists or integrated into an existing piece, bearing in mind time and cost efficiency for participating tattoo studios. 

Half a circle receives another half to become whole, symbolising the gift of life that is organ donation. The geometric shapes ‘O’ and ‘D’ form the acronym of ‘Organ Donor’.
We prioritised functionally, but it’s also a conversation starter, a statement, and proof of will for close family members who have the final say. It is supplemented by an updated tattoo consent form that includes an organ donation ‘opt-in’ clause. The typical consent form one needs to sign before getting inked. Symbolically, it is a commitment for life, to life, beyond skin deep.
A tattoo that comes with all the bragging rights. One you should definitely tell your family about.
The tattoo is the hero of the campaign, supported by an ecosystem of tattoo studios converted into ‘opt-in’ centres, artists turned advocates and an active medical community that contributes to its visibility and credibility. A comprehensive landing page was set up by teams at MRM London & Germany with all the info needed for ink lovers and artists alike.


The political Zeitgeist: In January 2020, the German parliament failed to pass a healthcare reform bill that would amend the law from an ‘opt-in’ system of explicit consent to an ‘opt-out’ system of presumed consent, with the aim of solving the issue of Germany’s ever-freefalling organ donation rate. A race against death as more than 10,000 people desperately await an organ transplant, while three of them die every day. 
In contrast to its European counterparts with an ‘opt-out’ system, Germany has one of the lowest organ donation rates with only 11.5 organ donors per million inhabitants - that’s 0.001% of the population. Striking, to say the least, in a global economic powerhouse with an advanced healthcare system such as Germany.
Even more striking when compared to the share of the population that supports organ donation, 84% of Germans consider organ donation the right thing to do according to surveys.  
We knew there was a funnel that resulted in a loss of potential donors. Above all, we knew the topic was taboo given its delicate nature. We’re talking about a decision that involves death, and no one wants to think about that. 
Initially, we thought that people weren’t taking the necessary steps to opt-in, which was partially true. However, in addition to a general lack of awareness, we discovered two other major problems:

The absence of a national register meant that there was no effective way of recording or tracking potential donors and their decision. In other words, only cardholders knew they had the card, unless they had informed someone. This brings an additional cultural factor to the problem, a general concern over data and privacy in Germany.
Regardless of its shape and form, the proof of consent must be communicated to the closest family members as they make the final decision regardless. According to the DSO, Germany’s federal coordination agency for organ donations, in 42% of the cases family members are unaware of the deceased’s decision and assume that the latter did not consent.



Proof of consent in this case could take any form and that was our initial starting point, we then had to define what that form was. 
With one in four people in Germany having at least one tattoo, the idea of an organ donor tattoo was a no-brainer.
#OPTINK was our first idea, which we measured against previous campaigns that attempted to solve the same problem. Its strength resided in several key factors: 
Immediately Recognisable: Final decision makers, your loved ones, will notice a change in your appearance.
Conversation Starter: As opposed to other forms of consent, a tattoo has to stop power. After all, the first question people would ask when they notice a new tattoo is “What’s the meaning behind your tattoo?” 
Timeless: It can’t be lost; you carry it with you forever.
Indisputable: Compared to other forms of consent, a tattoo is decisive. It’s inked on your skin. It’s definitive and harder to forge. 
Skin in the game: Although tattoos are literally superficial, #OPTINK goes deeper. It’s a life-saving commitment carried with one’s body for the body, and life, of others. 
It’s also worth noting that when we started developing this project, numbers pointed to one in eight Germans having a tattoo. That number subsequently evolved to one in five, then to one in four people inked post-pandemic. As the trend went upward, we knew we were on the right track. 
Death is never an easy topic, so we had to make sure it remained about life. The upside of walking through a minefield is that you’ll easily know when you take the wrong path. The concept of an organ donor tattoo was relatively straightforward. After all, its beauty is in its simplicity.
However, the challenges revolved around the ecosystem supporting the tattoo and making it accessible; how do you get all concerned stakeholders on board? Simultaneously? How do you recruit tattoo artists and convert their studios into ‘opt-in’ centres? How do you link potential donors to participating artists? How do you incentivise them? Inspire them to create their own interpretation. How do you streamline the recruitment process? How do you reach a maximum number of medical professionals? To what degree do they need to be aware given that the final decision is in the hands of family members? How do we get doctors to join actively? How do we target ink enthusiasts? Are people planning on getting inked? Existing customers of tattoo studios? How do we communicate with people without any tattoos? 

The idea was there, we just had to make it bigger, and most importantly, complete. We knew we had to target ink enthusiasts, tattoo artists and studios, medical staff and last but not least, the general public.
With regards to the design itself, it was a classic case of trial and error, with a list of mandatories of course. It needed to tick several boxes. Many darlings were indeed murdered in the process. RIP. 
We looked at a plethora of tattoo designs to try and find a sweet spot in terms of aesthetics that would appeal to as many people as possible. 



Perhaps one of the most interesting and challenging aspects was creating a design that is universal enough to be adopted by tattoo enthusiasts and first-timers alike, and minimal enough to be deployed on a large scale by artists at negligible costs. 
We didn’t know exactly what the tattoo should look like, but we knew how it shouldn’t.
Options using negative space were immediately discarded for instance, as it would’ve been too time-consuming, costly, and complicated to replicate on a large scale. Themes revolving around death such as skulls were to be avoided since we were finding a way to talk about death without mentioning it.
At one point, we even explored different degrees of functionalities, how much data should OPTINK carry? Would it allow potential donors to choose specific organs to donate? Would it include one’s blood type? Do we add a colour code or some sort of messaging? Eventually, we kept it single-minded, if you were going to ink your commitment to opt-in on your skin, you were either in or out, with no ifs or buts. A tattoo is not grey. Any exception would then have to be documented on the tattoo consent form and most importantly communicated to close family members.
We worked closely with several tattoo artists, ink enthusiasts, legal consultants, and doctors in various medical fields.
It was through discussions with transplantation officers that we discovered the importance of informing one’s closest family members. The recommendation for the ideal tattoo placement was a result of multiple consultations and interviews with general practitioners with experience in various federal health organisations. The ideal placement for #OPTINK is wherever it can be visible enough to spark a conversation with family members.
For instance, with regards to the colour and thickness of the design we consulted with a dermatologist, who among many things, recommended avoiding yellow or orange pigments as they aren’t well absorbed by currently commercially available laser lights, which would make the removal difficult should one decide to go back on their decision.
The original #OPTINK tattoo is the classic tattoo black, in fine lines. 
In addition to Gara, we worked with several other artists to better understand their concerns, challenges, and vision. The time frame of 10 minutes per tattoo was the mean average of recommendations by multiple artists. 
Though the sole purpose of emergency responders is to transport patients to the hospital as fast as possible, therefore they have no direct role in organ donation, their input was necessary to make sure the design is recognisable enough for them to alert the doctor, who would then inform family members, only if and after an official protocol determining brain death is established. Effectively we knew that the decision for organ donation would involve the donor, their family mainly, and their doctor.

All of whom would be aware of a tattoo such as #OPTINK. 
A dipstick survey with ink enthusiasts showed that #OPTINK resonated well with those who looked for tattoos with meaning. Others who favoured aesthetics over meaning, found its minimalism and symmetry appealing. And for those that followed a particular style of tattoos, the fact that #OPTINK can be reinterpreted by their favourite artist or added to an existing piece was much appreciated. 
Naturally, Junge Helden’s input and feedback throughout the process was crucial. 20 years of activism for organ donation awareness and reform meant that they understood the challenges we faced and the socio-political context. Finally, defining #OPTINK as proof of will and transforming a tattoo consent form into an organ donation consent form wouldn’t have been possible without the help and advice of legal teams on all sides.
At some point, some collaborators flirted with the idea of a connected/interactive tattoo to try and create a digital national register, however, that would’ve been a major cultural and historical ‘faux pas’. The fact that we’re shortcutting the problem by sparking a conversation with final decision-makers through explicit consent seemed powerful enough, and the decision to donate remains between the donor and their family members. The explicit proof of consent is the tattoo complemented by the signed #OPTINK tattoo consent form. Though given the shareability of #OPTINK and tattoos in general, social platforms have arguably become the national register. 


We started by focusing our efforts on the 25% of the population that has at least one tattoo. Start with the believers before convincing the non-believers. 

How do we launch it? Do we activate several tattoo studios at once? Is it a walk-in welcome or a tattoo flash day? A week? Or a month? We knew we had to get to a maximum number of ink enthusiasts. The reason why we chose a tattoo convention for a pilot test. 

The fact that people were there with the intention to get inked while browsing for meaning and design brought us one step closer to conversion. 
#OPTINK made its debut at Die Tattoo Convention in Braunschweig, one of Germany’s most prominent tattoo festivals with over 2,500 attendees. Our dedicated booth hosted partner artist, Silvia Lampreda, aka Blustorm, founder of House of Rituals in Berlin. #OPTINK was an instant success. Our booth was fully booked for two days and more than 35 people chose to #OPTINK.

One key learning was that the target audience was not limited to younger generations. It was surprising to see people from all walks of life #OPTINK. A considerable number of which had either a direct or indirect experience with death or illness. People who were affected one way or another by the cause, or a similar one.
We learned that conventions are not only a great way to reach a maximum number of tattoo fans, but also a way to connect with other artists and studios. We managed to get in touch with over 20 studios at that one convention alone. 
The timing was perfect as the Federal Minister of Health Lauterbach announced his intentions to reorganise organ donation in Germany one day following #OPTINK weekend at Braunschweig, this motivated us to push further in the hope of instigating concrete change.
We needed to maintain momentum until the national launch. Luckily, the convention gave us a pool of content that we leveraged on social media to target artists, people planning on getting inked and relevant influencers. Also, always make sure you have a spare tattoo machine and extra needles and gloves. 


With the invaluable support of Weber Shandwick Germany, #OPTINK was launched nationwide during an event celebrating Junge Helden’s 20th anniversary in Berlin in the presence of tattoo artists, celebrities, the medical community, and media personalities who endorsed the cause and got inked. The event was covered extensively by the press, with a comprehensive prime-time segment aired by Taff/ProSieben, one of Germany’s leading TV channels. The launch event generated more than 300 million impressions on TV and press alone, setting a snowball effect in motion and giving impetus to the cause.
Though we had initially assumed our niche would be limited to ink enthusiasts, surprisingly around 40% to 50% of people who #OPTINK have no previous tattoo whatsoever. Perhaps its meaning is strong enough to convince different generations to get their first tattoo. 
The map of participating tattoo studios allows us to determine the states that are naturally more receptive to the idea and regions that need more push. Bearing in mind that around 50% of tattoo studios have been recruited through PR or direct marketing efforts, such as email, cold calling, door-to-door, or direct messages on social, while the remaining 50% have joined the cause spontaneously, whether via the contact form on our landing page, our social media profiles, or word of mouth.
Social listening helps us continuously optimise our comms. material, such as the toolkits we provide artists, social assets targeting tattoo artists, fans and first-timers, or educational content aimed at the medical community and publications.
It’s fascinating and humbling to see how positively all stakeholders are engaging with #OPTINK. A tattoo is not a retweet. It requires a certain level of engagement and commitment, to say the least. Following the convention, one in three tattoos were shared on socials every week. That number subsequently evolved to one tattoo a day after the national launch and is currently at a rate of two to three tattoos a day on average. The fact that more than 100 people so far believed in the idea enough to ink it on their skin permanently is a testament to the power of its meaning and its universality. That’s more than 700 potential lives saved. 1 tattoo = 1 organ donor = 7 lives saved. And though traditionally, tattoos are not recommended by doctors, 80% of the medical workers we collaborated with got a tattoo.

As for tattoo artists, they went beyond the toolkit and guidelines we had initially developed to help them. They became real advocates, creating exclusive content and rallying their communities behind the cause.


We’d like to thank the client for their complete trust, and for having skin in the game – literally – as #OPTINK was the first tattoo for most of them.  
The first problem was a general lack of awareness. Given the impact the campaign has had so far, its extensive coverage, multiple endorsements, and earned media, we’re on the right track to maximising awareness. On Instagram alone, we’ve witnessed an 8% growth in Junge Helden’s follower base in under eight weeks. 
Moreover, #OPTINK managed to successfully transition from the awareness phase to advocacy.  Transforming tattoo studios into organ donation ‘opt-in’ centres gives the organisation a permanent physical presence across Germany, with inspiring tattoo artists as advocates, and ink enthusiasts as mouthpieces physically carrying the meaning. Creating in its wake a self-sustained structure with a constant stream of potential organ donors. 
Above all, #OPTINK gives people an accessible way to approach a sensitive matter. A way to talk about death and life, while making it social media friendly. 
Beyond its functional role, #OPTINK has everything it takes to become an international symbol for organ donation, a ‘movement’ as some might call it. Anecdotal evidence that points to that is perhaps the hero leaving stones with the #OPTINK symbol at random tattoo studios and sending us photos via the contact form, or even the shop that made #OPTINK apparel for children as they cannot get inked. The campaign is inclusive enough to extend beyond the tattoo community and the symbol is powerful enough to transcend a tattoo. 

Get inked. Give life.

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McCann Worldgroup Europe & London, Tue, 18 Apr 2023 16:15:00 GMT