title: Donation rates: what matters?
abstract: BACKGROUND
  The increase in the number of donors is the main objective of all transplantation organizations around the world. Further understanding of the factors involved in increasing donation rates is very important for planning future strategies to improve outcomes in each country.
  
  
  OBJECTIVE
  With this purpose we analyzed the relationship between social and economic factors of the countries and organizational aspects of health systems and institutions dedicated to transplantation in relation to the number of actual donors per million population. We analyzed rates of deceased donors per million population of Latin America, North America, and Europe (20 countries) and correlated them with the human development index and its most important indicators. We also studied the correlation with spending on health and organizational aspects of the health system.
  
  
  RESULTS
  On the one hand, we found that donation rates (DRs) per million population (pmp) were not statistically significantly correlated with the human development index (significant correlation 0.61 and 0.181). There is a correlation, albeit weak, between observed donation rates and gross domestic product (GDP) of each country (significance, 0.04; correlation, 0.46). On the other hand, there exists a strong correlation between the percentage of GDP spent on health and DRs pmp (significance, 0.01; correlation, 0.53). Those countries with an integrated national health system (P = .01) and a higher percentage of hospitals with intrahospital transplantation coordinators (P = .001) had higher DRs pmp.
  
  
  CONCLUSIONS
  The best DRs are closely linked to organizational aspects of the donation system in particular and the health system in general. There is a weak correlation between observed DRs and socio-economic and development indicators of countries. These data should be taken into account in planning future strategies to increase DRs, health plan policies, and investments.
authors.affiliation: Instituto Nacional de Donación y Trasplante, Montevideo, Uruguay. Electronic address: rmizraji@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Mizraji
authors.affiliation: Instituto Nacional de Donación y Trasplante, Montevideo, Uruguay.
authors.forename: M
authors.initials: M
authors.lastname: Godino
authors.affiliation: Instituto Nacional de Donación y Trasplante, Montevideo, Uruguay.
authors.forename: N
authors.initials: N
authors.lastname: Tommasino
authors.affiliation: Instituto Nacional de Donación y Trasplante, Montevideo, Uruguay.
authors.forename: I
authors.initials: I
authors.lastname: Alvarez
mesh_terms: D019033:Delivery of Health Care, Integrated; D019049:Developed Countries; D003906:Developing Countries; D005060:Europe; D059066:Gross Domestic Product; D006291:Health Policy; D006801:Humans; D007843:Latin America; D009656:North America; D012959:Socioeconomic Factors; D014019:Tissue Donors / Q000706:statistics & numerical data / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000706:statistics & numerical data*