Family decision-making regarding organ donation in Peru: an analysis of interviews and health systems

Abstract

Objective: To identify the sociodemographic, clinical, and institutional factors associated with family acceptance of organ donation and to describe the reasons for refusal reported by families of potential donors cared for in public and private healthcare facilities between 2014 and 2022.

Methods: This was an observational, cross-sectional, analytical study based on a secondary analysis of the institutional database of the Dirección General de Donaciones, Trasplantes y Banco de Sangre (Digdot). Of 7,074 records, those corresponding to facilities of the Ministerio de Salud, EsSalud, private clinics, and the Fuerzas Armadas y Policía Nacional del Perú that had complete information were included, while records without a family interview were excluded, yielding 1,668 cases for analysis. Sociodemographic factors (sex, age, and geographic origin), clinical factors (potential donor diagnosis), and institutional factors (donor-generating institution), as well as reasons for family refusal, were analyzed. Associations between variables were assessed using the chi-square test and the Mann–Whitney U test. Crude prevalence ratios (cPRs) and adjusted prevalence ratios (aPRs), with 95% confidence intervals (95% CIs), were estimated using Poisson regression with robust variance. The adjusted model included variables that were significantly associated in the bivariate analysis and were epidemiologically plausible.

Results: Family acceptance was 32.6%. A higher proportion of interviews was conducted in Lima and the central areas of the country. Significant differences were observed by age group (p = 0.001), with a lower proportion of children (3.9%) among cases with family acceptance. In the adjusted analysis, a higher prevalence of acceptance was observed among adults aged ≥60 years than among adults aged 30–59 years (aPR = 1.22, p = 0.039, 95% CI: 1.01–1.48). Likewise, the prevalence of acceptance was lower in the Fuerzas Armadas y Policía Nacional del Perú (aPR = 0.37, p = 0.033, 95% CI: 0.15–0.92) than in EsSalud. The main reasons for refusal were preservation of bodily integrity (38.0%), family disagreement (19.5%), and refusal expressed while alive (19.1%).

Conclusions: Family decision-making regarding organ donation in Peru is influenced by institutional factors and cultural beliefs, with differences according to the potential donor’s age. Strengthening training for healthcare personnel, promoting public information, and developing strategies sensitive to the potential donor’s age are key steps to reduce refusal rates and improve organ availability across all stages of life.