Organ Donation Refusals and Sociodemographic Determinants: Evidence from Northern Italy

Abstract Background Organ donation rates vary significantly across European countries-and even within regions of the same country-due to a combination of socio-cultural and regulatory factors. This study explores possible associations between the population's sociodemographic characteristics and the rate of recorded refusals to donate organs during identity card renewal across municipalities in a region in northern Italy. Methods Data on organ donation preferences collected through the national Transplant Information System (SIT) between 2019 and 2024 were analyzed and integrated with sociodemographic data from ISTAT databases. The units of the analysis were the municipalities. Average age, percentage of foreign residents, per capita income, education level, and gender distribution were included as factors potentially associated with the outcome variable (recorded refusals). Descriptive statistics, followed by univariable and multivariable multilevel linear regression models, were performed. Results A total of 1,173 municipalities were included. The average refusal rate to donate increased over time, reaching its peak in 2024 (30.6%). Multilevel multivariable regression analysis revealed a significant positive association between the proportion of foreign residents and refusal to donate (Adjusted Coefficient (AdjCoeff) 0.36; 95% Confidence interval (CI) [0.19; 0.53]). Conversely, both income and the proportion of adult males were negatively associated with refusal (AdjCoeff −0.000355; 95% CI [−0.0006234; −0.0000866] and AdjCoeff −0.29; 95% CI [−0.53; −0.05], respectively). Education level did not show a significant association. Conclusions These results underscore the importance of targeted communication strategies in socially vulnerable areas, possibly involving cultural mediators and community role models. Further studies could explore successful European strategies for increasing public awareness and promoting a more positive attitude toward organ donation. Key messages • Organ donation rates show marked territorial variability; exploring sociodemographic correlates may inform more equitable and effective health policy interventions. • Sociodemographic factors are associated with refusal rates to organ donation; foreign residency is linked to higher refusals, while income and male proportion show protective effects.