Evidence map›Paper›PMID 41068835›Full record

ArticleJournal of anesthesia, analgesia and critical care2025

Understanding organ donation refusal in the next of kin: a fifteen-year retrospective study in ten thousand potential donors.

Stefano Marelli, Lorenzo Querci, Federico Pozzi, Cristiana Cipolla, Giuseppe Piccolo, Marco Sacchi, Tullia De Feo, Massimo Cardillo, Arturo Chieregato

Abstract read
In one paragraph

Article in Journal of anesthesia, analgesia and critical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. The INTEGRITY guidelines - ethical guidance for research involving deceased donation and transplantation.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Stefano MarelliSchool of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.ORCID http://orcid.org/0009-0000-2780-8358
Lorenzo QuerciOspedale Niguarda Ca' Granda, Neurocritical Care Unit, Milan, Italy.ORCID http://orcid.org/0000-0002-2229-974X
Federico PozziOspedale Niguarda Ca' Granda, Neurocritical Care Unit, Milan, Italy.
Cristiana CipollaCoordinamento Regionale del Procurement Di Organi e Tessuti - AREU Lombardia, Milan, Italy.
Giuseppe PiccoloCoordinamento Regionale Trapianti, Direzione Generale Welfare, Milan, Regione Lombardia, Italy.
Marco SacchiCoordinamento Regionale del Procurement Di Organi e Tessuti - AREU Lombardia, Milan, Italy.
Tullia De FeoS.C. Trapianti-Lombardia, North Italian Transplant Program (NITp), Fond. IRCCS Ca' Granda Ospedale Maggiore Policlinico Di Milano, Milan, Italy.
Massimo CardilloS.C. Trapianti-Lombardia, North Italian Transplant Program (NITp), Fond. IRCCS Ca' Granda Ospedale Maggiore Policlinico Di Milano, Milan, Italy.ORCID http://orcid.org/0000-0002-2776-2297
Arturo ChieregatoOspedale Niguarda Ca' Granda, Neurocritical Care Unit, Milan, Italy. arturo.chieregato@ospedaleniguarda.it.ORCID http://orcid.org/0000-0001-6690-8597

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionRefusal of organ donation is influenced by a range of interconnected factors spanning donor characteristics, family dynamics, and intensive care unit (ICU) practices. This study explores the impact of donor or centre-related variables on organ donation refusal rates in Italian ICUs, among potential donors without expressed will.

methodsWe conducted a retrospective analysis of 12,930 potential donors registered in the North Italian Transplant Program registry from 01/01/2010 to 31/03/2025. A linear mixed-effects model was applied to account for donor characteristics (age, timing and cause of death, geographic origin) and ICU-level variability with refusal of organ donation.

resultsIn multivariate analysis geographic origin was an independent predictor of refusal - particularly for donors from North Africa and Middle East (OR 9.59, IQR 6.25 - 14.72; p-value < 0.001), Asia (OR 7.76, IQR 5.69-10.57; p-value < 0.001), Africa (OR 6.81, IQR 4.44 - 10.45; p-value < 0.001) and eastern European (OR 2.65, IQR 2.17 - 3.23; p-value < 0.001). Also, time from event to death over 48 h was associated with higher refusal rate (OR 3.37, IQR 2.52 - 4.50, p-value < 0.001). In contrast, traumatic brain injury (OR 0.85, IQR 0.74 - 0.98; p-value 0.023) was protective. Finally, inter-ICU variability had a significant impact on refusal rates, as indicated by a Median Odds Ratio of 1.38. However, the multivariate model demonstrated weak predictive ability for organ donation refusal (AUC = 0.66).

conclusionsThis study identifies several factors independently associated with organ donation refusal. However, the overall predictive ability based on available variables remains limited. To enable individualized interventions and effectively reduce refusal rates, more comprehensive and prospective data collection is warranted.

Indexed as

Donor-specific factorsGeographic originICU-specific factorsIntensive Care Units variabilityOrgan donationRefusal

Identifiers

PMID41068835
PMCPMC12513025

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.