EXPERIMENTAL AND CLINICAL TRANSPLANTATION

Objectives: We evaluated the knowledge, attitudes, and barriers surrounding organ donation among medical students in southwest Iran.Materials and Methods: A questionnaire was prepared for this sociological and cross-sectional study. Our study included 136 student participants (mean age of 24.6 ± 2.3 years). Most students were men (55.1%) in year 7 of studies (23.5%) in Shiraz in southwestern Iran.
Results: Among 136 participants, 86.6% (n = 118) indicated support for organ donation, 9.6% (n = 13) were uncertain, and 3.7% (n = 5) did not support organ donation. Few students (16.9%) understood the organ donation system. The awareness level of the country’s current organ donation system among participants in different years of studies did not differ (P > .050). Almost 69.9% of the participants (n = 95) stated that doctors should promote organ donation to the general public.
Conclusions: Health care professionals have a vital role in increasing the number of organ donors. Educational programs would enhance medical students’ knowledge and attitudes about organ donation and transplan-tation. In addition to the influence of health care professionals, the support of the media and religious leaders should also be noted to boost organ donation.

Key words : Awareness, Opinion, Organ transplant, Transplantation, Willingness

Organ transplantation has kept and enhanced the lives of individuals who have developed end-stage organ failure. Despite the worldwide increasing rate of organ transplants, the demand for organ donation, including both deceased and living donation, has remained unmet, and the demand reported for 2023 was 9.5% higher versus the data from 2022, with a rate of 20 transplants per hour in 2023.¹
The discrepancy between the number of donors and the need for organs required for transplant is a leading cause of death for patient on the wait list.² Although living or deceased donors can supply transplantable organs and tissues, each has specific criteria and limitations. For example, living donation involves the donation of a kidney, a partial liver, or a lung.³ For deceased donation, medics utilize donations from circulatory-death donors and make decisions following a series of death determinations by neurologic criteria, the definitions and criteria of which have been refined from previous protocols. Moreover, organ-specific guidelines for kidney, pancreas, liver, and lung transplantation have also been specified.^4,5
Several key factors contribute to the request and donation of organs for transplant. Religious and cultural barriers, as well as sociocultural aspects, are among the primary sources of variability in attitudes toward donation among studies from different geographical areas. Similarly, protocols in each country may be influenced by specific cultural and religious backgrounds.^6-8 To be exact, people of Muslim faith who reside in Western countries have more negative attitudes toward organ transplantation and donation than people from other religious backgrounds, for which key concerns include know-ledge paucity regarding organ donation, distrust of the health care system, family beliefs, variable interpretations of religious rulings, and perceived views of spiritual leaders.^9,10 Finally, sociodemo-graphic aspects such as age, sex, and education level have also influenced attitudes toward donation and transplant.¹¹
Raising awareness and dispelling misconceptions regarding organ donation among the general popu-lation could enhance organ donor availability. As a cornerstone of the health care system, medical students (prospective physicians) and health care professionals should have a proper perspective and understanding of organ donation to foster a society and environment that positively influences organ donors and donation rates.^12,13 Accordingly, a litera-ture review indicated that attitudes and knowledge of organ donation were different among medical students from diverse geographical areas and sociocultural backgrounds.^14-17 Despite a favorable attitude toward organ donation and transplantation in 2 studies conducted in northern Iran, the numbers of registered donors and the basic understanding and knowledge of organ donation and transplantation were low.^2,18
This study evaluated the knowledge, attitudes, and barriers surrounding organ donation among medical university students in southwest Iran.

Materials and Methods

Study design and participants
This sociological, cross-sectional, and observational study was conducted in Shiraz, in southwest Iran, in 2025 to measure medical students’ knowledge and attitudes toward organ transplantation. After approval by the Ethics Committee of Shiraz University Medical Sciences (approval ID: IR.SUMS.REC.1404.29), we recruited all undergraduate medical students who met the specified inclusion criteria in prespecified criteria. The inclusion criteria were medical students aged 18 years or older who studied at Shiraz University of Medical Sciences and had no history of employment or participation in organ donation or transplant. Informed consent was required for participation in the study, and participants who were absent or refused to provide consent were excluded from the study. In our study, 136 medical students participated in the survey voluntarily and anonymously. In advance of receiving the questionnaire, the structure and content were explained to participants, who were provided with instructions to guide them through the questions.
Questionnaire
We used an anonymous, web-based questionnaire to gather information on demographic characteristics, knowledge, and attitudes toward organ donation and transplantation. The questionnaire contained several question types related to demographic charac-teristics, attitudes toward self-donation and organ donation in general, knowledge level of organ donation and transplantation, problems regarding organ donation, and suggestions regarding increasing organ donation (Table 1). Our questionnaire design was based on a study by Hulya Sahin and Osman Abbasoglu.¹⁹ Regarding the questions that measured knowledge, the expected responses were counted as 1 point, and incorrect responses were given a value of 0. The range for the total knowledge score was between 0 and 14 points. We classified the respon-dents into 2 categories based on their mean scores. Those respondents who scored a summed know-ledge equal to or higher than the mean score were categorized as having an “above-average knowledge level.” In contrast, the other participants had a “below-average knowledge level.”
Statistical analyses
We used SPSS software (version 16.0; IBM) for statistical analyses. We presented qualitative variab-les as frequencies and percentages and quantitative variables as mean values with SD. We compared results with chi-square test, Pearson correlation, t test, and analysis of variance. P < .05 was considered significant.

Among the 136 medical students who participated in the study, mean age was 24.6 ± 2.3 years (range, 21-30 years). Most students were men (75 cases, 55.1%) and in year 7 of studies (23.5%).
During completion of the questionnaire, most participants (86.6%, n = 118) expressed support for organ donation, whereas a small proportion (3.7%,n = 5) did not. When asked to self-assess their level of knowledge about organ donation, a single participant (0.7%) reported having sufficient knowledge. Only 16.9% (n = 23) demonstrated an understanding of national legislation and the procedures surrounding organ donation. This finding did not differ across academic levels (P > .050). Regarding medical doctors’ attitudes toward organ donation, 69.6% (n = 95) of participants indicated that doctors should promote organ donation to the general public, whereas 5.1% (n = 7) believed that doctors should not encourage organ donation (Table 1). Overall, most respondents (91.9%, n = 125) supported organ donation, a rate consistent across sex and academic year groups (P > .050). In addition, 55.1% (n = 75) expressed willingness to donate their organs in the future, with only 8.8% (n = 12) indicating they did not wish to do so. Notably, 65.4% (n = 89) had not participated in any medical school education program related to organ donation.
Regarding the understanding of brain death, 79.4% of students correctly identified brain death as the patient’s irreversible death (Table 2). In addition, 89.7% of respondents accurately distinguished between brain death and coma. However, a signi-ficant misconception persists, as 64.7% of partici-pants (n = 88) incorrectly believed that a donor does not need to die in a hospital setting for deceased-donor transplants. Knowledge about the transplant ability of specific organs varied, with the lowest correct awareness observed for the uterus (27 cases, 19.9%) and the small intestine (49 cases,36.0%). Conversely, understanding of heart and bone marrow transp-lantation was notably high, with 95.6% (130 cases) and 90.4% of students (123 cases), respectively, demonstrating accurate knowledge.
Among sex and academic year groups no signi-ficant differences were shown in understanding of brain death, its irreversibility, or the comatose state (P > .050), which indicated a consistent level of awareness among the student population.
The mean total knowledge score was 8.2 ± 2.0 (range, 0.0-13.0). When stratified by sex, the mean total knowledge score for men was 8.2 ± 1.9, whereas for women it was 7.9 ± 2.1, with no significant difference (P > .050). Approximately 45.0% of partici-pants achieved an above-average knowledge score, with no difference by sex (P > .050). No significant correlation was shown between age and total knowledge scores (r = 0.10; P = .163). In addition, we observed no significant relationship between know-ledge level and the degree of education (P = .327).
Although participants who had attended educa-tional programs exhibited slightly higher mean scores (9.0 ± 2.2) than those who had not attended educational programs (8.1 ± 1.5), this difference was not significant (P = .330).
Approximately 78.7% of participants (n = 107) viewed the lack of public awareness as the most important contributing factor to the shortage of organ donors. The responses also highlighted religious beliefs and ethical concerns as notable obstacles (Table 3).
When asked to suggest the most effective stra-tegies to enhance organ donation rates, participants most commonly endorsed increased support and advocacy from the media, as well as endorsements from religious leaders, and these responses reflected the importance of societal and cultural influences to shape public attitudes (Table 4).

Health care professionals can substantially influence the attitude of the general public toward organ dona-tion and transplantation. Health care professionals are more successful in obtaining consent to donation when they believe that the process would aid organ donation and transplantation, and the efforts of health care professionals can help remove barriers and promote organ donation.²⁰
In our study of knowledge and attitudes of 136 medical students at Shiraz University of Medical Sciences regarding organ transplant, an encouraging 91.9% of participants expressed support for organ donation, indicating a generally positive attitude within this group of future health care workers. However, when considering personal commitment, only 55.1% of participants stated they would be willing become organ donors in the future. This rate was lower than the 67.5% reported in a similar study conducted in Ethiopia and higher than the 37% observed in Cyprus research.^21,22 These findings highlight a notable gap between ideological support and personal willingness to donate and underscores the importance of targeted educational interventions to bridge this divide and foster genuine readiness for organ donation.
Similar to our study, a Turkish survey reported in 2015 that the lowest rates of correct knowledge among participants regarding organs to be transp-lanted was for the uterus, small intestines, and face.¹⁹ We discovered that only 28.8% of the participants knew the proper information about the statement, “A donor must die in the hospital for the deceased-donor transplant.” A total of 79.4% knew the irreversibility of brain death, and 7.4% deemed coma and brain death to be the same. In a study by Bardell and associates, 64% of Canadian medical students correctly noted the distinction between brain death and coma versus nearly 90% in our study.²³ Discrepancies among different studies regarding knowledge and attitudes toward organ donation may be due to variations in culture, religion, and type of questionnaire.^13,24-26
According to a study conducted in Poland among medical student, views on the possibility of recovery for people declared brain-dead showed significant differences based on the sex of the participants and their year of study, with more women than men having this opinion. This opinion was also pro-minent in the first 3 years of the survey.²⁷ Consi-dering this view, our study population showed no significant differences between sexes or across study years.
When the participants were asked to identify the most influential reasons for donor shortages, the 3 most common replies were “lack of knowledge in the general public,” “religious beliefs,” and “ethical problems.” With regard to obstacles to organ donation, especially in countries with large Muslim populations, religious beliefs are the first and most significant deterrent, as marked in prior studies.^28,29 Religious leaders among Muslim populations have considerable influence within their communities. Because Muslim people in Western countries form a substantial proportion of the immigrant population, health care professionals should engage them in education, as the involvement of health care pro-fessionals can immensely improve the acceptance and effectiveness of medical advice among the general population.¹⁰

Improvements in health care professionals’ know-ledge and attention to cultural and religious barriers can crucially increase organ donation rates. In addition, students’ knowledge should be reviewed in conjunction with relevant individuals, such as teachers, nurses, and other educators.
Implementation of targeted strategies, such as inte-ractive workshops, could modify medical students’ perceptions and foster positive beliefs toward organ donation, potentially increasing donation rates. Engagements with religious leaders could also help bridge the gap between support and personal willingness and thereby ultimately improve donation rates.

Volume: 23 Issue: 12 December 2025

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