Hospital-Related Determinants of Refusal of Organ Donation in France: A Multilevel Study

Régis Bronchard (), Gaëlle Santin, Camille Legeai, Anne Bianchi, Séverine Grelier, Caroline Bogue, Olivier Bastien and François Kerbaul
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Régis Bronchard: Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France
Gaëlle Santin: Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France
Camille Legeai: Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France
Anne Bianchi: Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France
Séverine Grelier: Pôle Sécurité Qualité, Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France
Caroline Bogue: Pôle Recherche Europe International et Veille, Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France
Olivier Bastien: Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France
François Kerbaul: Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, 93212 Saint-Denis la Plaine, France

IJERPH, 2025, vol. 22, issue 4, 1-13

Abstract: In a worldwide context of organ shortage, refusal of organ donation remains the main reason for the non-procurement of organs from deceased donors. Many studies have characterized the clinical or psychological factors of refusal but not organizational and structural factors in healthcare centers. We used multilevel logistic regression models with hospitals as a random effect to analyze organ procurement among 6734 potential brain-dead donors recorded in the national register in France in 2018 and 2019. According to the opt-out law, 29% of the potential donors refused to donate. Among hospital-related factors, low probability of refusal was related to hospitals audited for the organ donation process by the national program (adjusted odds ratio [aOR] 0.74, 95% confidence interval [CI]: 0.58–0.94), hospitals with high inpatient satisfaction scores for care (aOR 0.95, 95% CI 0.92–0.99) and facilities with a high ratio of nurse donor coordinators to donors (aOR: 0.78; 95% CI: 0.64–0.95). Among clinical factors, the odds of refusal were associated with age younger than 65 years (18–49 years; aOR 1.58, 95% CI 1.37–1.83) and donors with blood group B (aOR 1.32, 95% CI: 1.10–1.59). Hospital-related factors are just as important as individual factors in the procurement of organs from potential brain-dead donors.

Keywords: donation after brain death; refusal; hospital-related determinants; organ donation process audit; multilevel analysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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