Reasons for Family Refusal of Cadaveric Donation for Transplantation Purposes at the Mexican Social Security Institute, General Hospital Zone 1, Tlaxcala, March 2024 to March 2025.

Abstract

Introduction. Organ and tissue donation is an essential component in the care of patients with diseases that compromise organ and tissue function, as it promotes comprehensive rehabilitation through functional recovery, social reintegration, and improved quality of life. However, low donation rates persist in Mexico, with family refusal being one of the main barriers. Identifying the reasons that influence such refusal is essential to guide institutional strategies for awareness and donation promotion. Objective. To describe the reasons for family refusal of cadaveric donation for transplantation purposes and the sociodemographic characteristics of the secondary decision-maker at General Hospital Zone No. 1 (HGZ No. 1) of the Mexican Social Security Institute (IMSS), Tlaxcala, from March 2024 to March 2025. Methodology. A descriptive, retrospective, and observational study was conducted through the analysis of institutional family refusal forms registered at the Hospital Coordination Office for Organ and Tissue Donation of HGZ No. 1 Tlaxcala. A total of 58 complete forms containing information on the secondary decision-maker, including age, sex, educational level, religion, and relationship to the deceased, as well as the reasons for refusal, were included. A descriptive statistical analysis was performed using frequencies and measures of central tendency. In some cases, more than one reason for refusal was recorded on the same form; these were considered for an analysis by categories. Results. A total of 58 family refusal forms were analyzed. The age of the secondary decision-makers ranged from 23 to 74 years, with a mean age of 47 years and a predominance of women. The most frequent relationship to the deceased was wife, followed by children, husbands, and parents. The most common educational level was completed secondary education, followed by upper secondary education and undergraduate education, and the predominant religion was Catholicism. Regarding the reasons for family refusal, uncertainty about the deceased person’s wishes was identified as the most important reason. The second most frequent reason was related to prior expressed wishes, and the third most important category involved cultural reasons, particularly the belief that the body should be buried complete. Other reasons, such as religious motives, misinformation about the donation process, dissatisfaction with medical care, and other diverse arguments, were less frequent. It should be noted that more than one reason for refusal was recorded in some forms, reflecting the complexity of the family decision-making process. Conclusions. At HGZ No. 1 Tlaxcala, family refusal of cadaveric donation is mainly associated with lack of certainty regarding the deceased person’s wishes and the existence of a prior explicit refusal, followed by cultural beliefs related to bodily integrity. The presence of multiple reasons in some cases highlights the complexity of the family decision-making process. These findings provide local evidence that may guide educational strategies aimed at promoting the prior expression of the willingness to donate and strengthening the culture of organ and tissue donation.