Stem cell donation has become an important component of contemporary regenerative medicine, particularly in the treatment of hematological malignancies, immune deficiencies, genetic disorders, and selected metabolic diseases. However, its implementation in Muslim Gulf societies remains shaped by medical awareness, legal clarity, institutional readiness, and religious-ethical considerations. In this study, we examined community and physician perspectives on stem cell donation in the Gulf Cooperation Council context, with particular attention to Islamic jurisprudence, ethical values, and regulatory frameworks. We adopted an integrative design, combining doctrinal legal and jurisprudential analysis with 2 cross-sectional surveys. The community survey included 65 participants and examined awareness, perceived barriers, religious considerations, registration intention, and willingness to donate. The physician survey included 55 medical doctors and assessed professional knowledge, perceived therapeutic importance, institutional support, legal awareness, and policy preferences. Findings showed that both community members and physicians recognized the humanitarian and therapeutic value of stem cell donation, yet this positive perception had not translated into active registration or strong system-level engagement. Among community participants, lack of information, uncertainty regarding religious rulings, and limited awareness of registration mechanisms emerged as key barriers. Among physicians, limited familiarity with legal frameworks and inadequate institutional support were central constraints. Strengthening stem cell donation in the Gulf Cooperation Council requires coordinated educational initiatives, clear religious guidance, stronger institutional training, and legally transparent opt-in donation systems that respect cultural, ethical, and religious sensitivities. Key words: Community awareness, Explicit consent, Gulf Cooperation Council, Islamic bioethics, Legal framework, Physicians, Regenerative medicine, Shariah

Introduction
Stem cell transplantation is one of the most significant developments in contemporary medicine, offering therapeutic possibilities for patients with life-threatening hematological, genetic, immune, and metabolic conditions. Hematopoietic stem cell transplantation, in particular, has become an established intervention for restoring blood production and immune function when bone marrow is damaged by disease or intensive treatment. In many clinical cases, transplantation is not merely supportive or palliative but may provide a curative option that improves survival and quality of life.¹ The clinical value of stem cell transplantation, however, depends not only on scientific and technical capacity but also on donor availability, public trust, institutional readiness, and the presence of clear ethical and legal frameworks. Globally, donor shortages remain one of the major barriers limiting the effective use of stem cell transplantation. Shortage problems become more complex in regions where public registration in donor programs is limited and where social, religious, and legal concerns influence health-related decision-making. In the Gulf Cooperation Council (GCC) countries, health care systems have made notable progress in advanced medical services, including transplantation and regenerative medicine. Yet the development of clinical infrastructure has not always been matched by equivalent growth in public awareness, donor registration, or professional familiarity with the legal and ethical dimensions of stem cell donation. This creates a gap between medical possibility and practical implementation, especially when patients require compatible donors within genetically and culturally specific populations.^1,2 Stem cell donation occupies a sensitive position at the intersection of medicine, law, ethics, and religion. Clinically, stem cells may be obtained from sources such as bone marrow, peripheral blood, umbilical cord blood, placental tissue, and, in some research contexts, embryonic material. These sources do not carry the same ethical or jurisprudential implications. Islamic bioethics generally permits stem cell donation and therapeutic use when the source is lawful, informed consent is obtained, donor harm is avoided, human dignity is preserved, and commercialization is prohibited.^3-5 Therefore, the issue is not whether stem cell donation is categorically acceptable or unacceptable, but under what conditions it becomes medically, ethically, legally, and religiously permissible. In Muslim societies, religious considerations play an important role in shaping public attitudes toward donation-related practices. Islamic jurisprudence places strong emphasis on the preservation of life, removal of harm, compassion, altruism, and social solidarity. These values can support stem cell donation when it is conducted within legitimate Shariah controls and medical safeguards. However, public uncertainty may arise when people lack access to clear religious guidance or when communication between religious authorities, health care institutions, and the public is weak. In such contexts, religious concern may function less as an outright barrier and more as a need for reassurance, clarification, and authoritative guidance.^5-7 The legal context further complicates the issue. Gulf countries do not regulate stem cell donation in a uniform manner. Some legal systems explicitly address stem cell donation within broader organ and tissue transplant laws, whereas others exclude stem cell transplantation from such laws or remain silent on the matter. This uneven regulatory landscape may affect public confidence, physician guidance, and institutional practice. In the United Arab Emirates, for example, stem cell-related practices are shaped by general principles of informed consent, bodily integrity, human dignity, noncommercialization of the human body, medical liability, and regulatory oversight of stem cell storage and clinical practice. Although these principles provide important safeguards, the absence of a single unified statutory framework specifically dedicated to stem cell donation may still create ambiguity for both health care professionals and potential donors. Previous research in Muslim-majority contexts has shown that awareness of donation and transplantation is often fragmented. Many individuals possess generally positive attitudes toward donation but lack accurate knowledge about eligibility, risks, procedures, legal protections, registration systems, and religious rulings. Similarly, health care professionals may recognize the clinical importance of stem cell donation but remain uncertain about legal obligations, institutional policies, or appropriate ways to communicate religious and ethical concerns to patients and families.^8-11 These dual gaps among the public and physicians are particularly important because effective donation systems require both informed communities and professionally prepared health care providers. Against this background, in the present study, we examined stem cell donation in the GCC context through an integrated ethical, jurisprudential, legal, and empirical lens. We investigated 2 complementary perspectives: community members as potential donors and physicians as key professional actors in patient counseling, donor identification, and policy implementation. Specifically, the study explored levels of awareness, religious and ethical perceptions, legal understanding, willingness to donate, perceived barriers, and preferred policy directions. By linking empirical findings with Islamic jurisprudential principles and Gulf regulatory considerations, we sought to provide practical insights for strengthening stem cell donation systems in culturally and religiously sensitive health care environments. The contribution of this study lies in its combined focus on public and physician perspectives within a broader normative framework. Rather than treating stem cell donation only as a medical procedure, the study approached stem cell donation as a multidimensional issue shaped by knowledge, trust, law, religious guidance, institutional readiness, and ethical governance. This approach is especially relevant for GCC countries, where medical innovation must be aligned with Islamic values, legal safeguards, and public confidence. The study argued that improving stem cell donation in the Gulf does not require abandoning culturally grounded consent models. Instead, improved donation requires strengthening explicit consent systems through reliable medical education, clear fatwas, stronger physician training, transparent legal guarantees, and coordinated institutional communication.

Medical, Jurisprudential, Ethical, and Legal Background
Stem cell donation must be examined through an interdisciplinary framework because it is not only a medical procedure but also a legal, ethical, and religiously sensitive practice. Medically, hematopoietic stem cell transplantation (HSCT) has developed from early experimental bone marrow procedures into a standardized therapeutic intervention for malignant and non-malignant diseases. Historically, HSCT emerged from discoveries related to bone marrow function, hematopoiesis, and the possibility of restoring blood-forming capacity after radiation exposure or intensive chemotherapy.^12,13 Its central therapeutic purpose is to replace damaged or diseased bone marrow with healthy hematopoietic stem cells capable of restoring blood production and immune function.¹⁴ The clinical importance of HSCT is evident in the treatment of leukemia, lymphoma, multiple myeloma, inherited immune deficiencies, selected genetic disorders, and metabolic diseases. In autologous transplantation, patients receive their own previously harvested stem cells, mainly to restore marrow function after intensive treatment. In allogeneic transplantation, stem cells are obtained from another person, commonly a sibling or matched unrelated donor, making donor availability and compatibility central to treatment success.^12,14 This distinction is important for the present study because donor participation is not merely an individual choice; donor participation is a structural requirement for the effectiveness of transplant systems. The development of HSCT was shaped by several important scientific advances. Early work by Thomas and colleagues¹³ demonstrated that intravenously infused bone marrow cells could contribute to hematopoietic recovery after radiation and chemotherapy. Later developments, including transplant between genetically identical individuals, improved understanding of immune rejection, and the clinical application of human leukocyte antigen typing transformed HSCT into a more reproducible and clinically viable procedure.^15-17 Landmark transplant cases in 1968 further demonstrated the possibility of immune reconstitution and long-term engraftment in inherited immune disorders.^18-20 Contemporary practice now uses different sources of stem cells, including bone marrow, peripheral blood, and umbilical cord blood, allowing treatment to be tailored to patient needs and donor availability.^20,21 Despite these medical advances, HSCT remains associated with risks such as infection, graft failure, graft-versus-host disease, conditioning-related toxicity, and other complications.¹⁴ These risks do not undermine the value of stem cell donation, but they make ethical governance essential. Donor protection, informed consent, accurate medical counseling, professional competence, and institutional accountability are necessary to ensure that donation is conducted in a way that balances therapeutic benefit with the prevention of harm. From an Islamic jurisprudential perspective, the permissibility of stem cell donation is assessed according to the legitimacy of the source, the medical purpose, the degree of harm, and the preservation of human dignity. Islamic bioethics generally permits the therapeutic use of stem cells when they are obtained from lawful sources, used for legitimate medical purposes, and governed by conditions such as informed consent, noncommercialization, and avoidance of serious harm.^3,4 This position is consistent with wider Islamic legal principles that prioritize the preservation of life, removal of harm, and realization of public benefit. Islamic juristic discussions distinguish between different sources of stem cells because not all sources carry the same ethical and legal ruling. Stem cells obtained from consenting adults, children under guardian consent and strict safeguards, placental tissue, umbilical cord blood, and spontaneously aborted fetuses under legitimate conditions are generally treated more favorably in contemporary jurisprudential discussions.^22,23 Placental and umbilical cord stem cells occupy a particularly acceptable position because these tissues are normally discarded after childbirth and their use does not harm either the mother or the newborn, provided that parental consent is obtained.²² In contrast, stem cells derived from intentional abortion without a valid Shariah-based medical justification are prohibited because the unlawful source affects the permissibility of subsequent use.²⁴ Therapeutic cloning also remains highly contentious and is rejected by the dominant juristic position because of concerns related to human dignity, interference with creation, and potential social and ethical harms.²⁴ The Islamic Fiqh Academy resolution on stem cell research and therapy reflects this distinction by permitting stem cells obtained from lawful and ethically controlled sources while prohibiting sources such as intentionally aborted fetuses without Shariah justification, fertilization involving unrelated donors, and therapeutic cloning.²⁵ Beyond formal jurisprudential permissibility, stem cell donation is also supported by wider Islamic and humanitarian values. The preservation of life is one of the higher objectives of Islamic law, and donation may serve this objective when it contributes to saving patients or improving their quality of life.^26,27 Compassion, altruism, and cooperation in righteousness provide an ethical foundation for encouraging donation when the practice is medically safe and legally regulated. The Qur’anic emphasis on mercy, preference for others, and cooperation in righteousness supports the moral logic of donation as a form of social solidarity and public benefit. Within this framework, stem cell donation may be understood as a contemporary application of Islamic ethical responsibility, provided that it respects bodily integrity, avoids exploitation, and remains free from commercial exchange.^28-30 The legal regulation of stem cell donation across the Gulf Cooperation Council countries is not uniform. Some jurisdictions include stem cell donation within broader organ and tissue transplant laws, whereas others exclude it from such laws or do not address stem cell donation explicitly. Oman provides an example of explicit legal regulation, as Royal Decree No. 44 of 2025,³¹ which recognizes stem cell donation under strict conditions, including safeguards related to minors and legally incapacitated persons. In contrast, the United Arab Emirates (UAE) excludes stem cell and blood cell transplant procedures from the direct scope of its organ and tissue transplant legislation, meaning that stem cell donation is governed indirectly through constitutional principles, medical liability rules, informed consent requirements, bioethics regulations, and health authority decisions. Although the UAE does not have a single dedicated statute governing stem cell donation, several legal principles remain directly relevant. These include the inviolability of the human body, the right to bodily integrity, the protection of human dignity, the requirement of informed consent, and the prohibition of treating the human body or its parts as commercial objects. Federal Decree-Law No. 25 of 2023 on the Donation and Transplantation of Human Organs and Tissues emphasizes donation without compensation and the protection of donors and recipients.³² Similarly, UAE legal principles require full disclosure and voluntary consent before medical intervention, whereas medical liability rules reinforce the duty of physicians to explain treatment options, risks, and possible complications before any procedure is undertaken. The UAE also regulates related areas of practice, including medically assisted reproduction, stem cell storage, cord blood banking, and physician licensing. Federal Law No. 7 of 2019 on Medically Assisted Reproduction requires written consent and full explanation of medical procedures, risks, and success rates.³³ Cabinet Resolution No. 6 of 2019 establishes licensing, operational, and supervisory requirements for stem cell and cord blood storage centers, including confidentiality, record keeping, traceability, and compliance with technical standards.³⁴ Cabinet Resolution No. 25 of 2020 further requires that physicians conducting transplantation-related procedures obtain authorization from the competent health authority.³⁵ These legal safeguards indicate that, even where stem cell donation is not regulated under one unified law, it remains governed by broader principles of consent, dignity, noncommercialization, professional accountability, and institutional oversight. Taken together, the medical, jurisprudential, ethical, and legal literature indicates that stem cell donation is not inherently rejected within the Gulf or Islamic context. Rather, its acceptability depends on lawful sources, informed consent, donor safety, noncommercialization, religious clarity, legal transparency, and institutional trust. This framework is important for interpreting the empirical findings of the present study. Public hesitation may not reflect rejection of stem cell donation itself but uncertainty about religious rulings, legal guarantees, health risks, and registration mechanisms. Similarly, physicians may recognize the clinical value of stem cell donation while lacking sufficient knowledge of legal frameworks, institutional procedures, or culturally appropriate ways of addressing religious concerns. Therefore, strengthening stem cell donation in the GCC requires an integrated approach that combines medical education, Shariah clarification, legal communication, professional training, and public awareness.

Methodology
This study adopted an integrative mixed-methods design that combined doctrinal analysis with cross-sectional survey data. The qualitative component examined relevant Islamic jurisprudential sources, ethical principles, medical literature, and legal regulations related to stem cell donation, with particular attention to the UAE and selected GCC countries. This component was used to contextualize the empirical findings within broader Shariah, ethical, legal, and medical frameworks. The quantitative component consisted of 2 structured surveys administered to community members and physicians in the GCC context. The community sample included 65 adult participants, and the physician sample included 55 licensed medical doctors. Both groups were recruited through convenience sampling due to the exploratory nature of the study and the absence of comprehensive sampling frames. Although this sampling strategy limits generalizability, we found it to be appropriate for identifying initial patterns of awareness, willingness, perceived barriers, and institutional challenges in an under-researched area. For the 2 conceptually aligned questionnaires, each contained 23 items, producing 46 items across both instruments. The community questionnaire focused on public awareness, religious and ethical perceptions, legal understanding, perceived barriers, registration status, and willingness to donate. The physician questionnaire focused on professional knowledge, perceived therapeutic importance, legal and regulatory familiarity, institutional support, clinical exposure, willingness to donate, and perceived system challenges. The items were mainly closed-ended to support descriptive statistical analysis and comparisons between the 2 participant groups. The instruments were developed based on the objectives of the study and informed by the medical, legal, ethical, and jurisprudential literature reviewed in the background section. Content and face validity were addressed through careful review of item relevance, clarity, and alignment with the study constructs. We analyzed data using descriptive statistics, which included frequencies and percentages. We interpreted the findings in relation to the study’s legal, ethical, and Islamic jurisprudential framework.

Results
Results are presented according to the 2 empirical components of the study (community participants and physicians). To fit the scope of the article, the findings are reported in integrated form, focusing on the main patterns related to awareness, willingness, religious and legal considerations, perceived barriers, institutional readiness, and policy preferences. The main findings of the community survey and physician survey are summarized in Table 1 and Table 2, respectively.

Community awareness, attitudes, and willingness to donate
Among the 65 participants in the community sample, most were female (76.9%) and university graduates (84.6%). General exposure to stem cell donation existed among the sample, but detailed knowledge on stem cell donation remained limited. Although 80% of participants reported some level of prior awareness, only 9.2% stated that they had sufficient information. In addition, 41.5% reported limited information, and 29.2% had only heard about stem cell donation. Knowledge of donor eligibility was also weak, as 41.5% did not know who could donate stem cells, and only 29.2% correctly identified that donation may involve both living and deceased donors. Religious and ethical uncertainty was also evident. Only 27.7% of respondents viewed stem cell donation as permissible under Shariah controls, 36.9% believed that a formal religious edict was needed, and 29.2% were uncertain. However, religious concern did not appear as direct rejection. Rather, many participants noted needing clearer religious guidance before making a donation decision. That is, 26.6% identified a clear fatwa as a factor that would support a positive decision. In addition, actual consultation with religious scholars was low, with 89.2% never consulting a scholar about stem cell donation. The gap between positive attitudes and actual behavior was particularly clear. Only 3.1% of participants were registered in an organ donation program, and 29.2% were considering registration. More than half of the sample (52.3%) were unaware of registration programs. Willingness also varied according to the donation context. Only 15.4% were definitely willing to donate stem cells after death, and 70.8% were either undecided or responded “maybe.” In contrast, a willingness to donate to a living family member was higher, with 34.9% willing without hesitation and 35.4% willing under certain conditions. Lack of information was the most frequently reported barrier to donation (59.2%), followed by fear of health risks (18.4%) and religious reasons (14.3%). Participants identified reliable medical information (29.8%) and clear religious guidance (26.6%) as the most important factors supporting a positive donation decision. They also preferred media campaigns, educational programs in schools and universities, donor and recipient testimonials, and mosque-based awareness activities as strategies for improving public awareness.

Physician knowledge, institutional readiness, and policy preferences
Among 55 medical doctors in the physician sample, 63.6% were female and 49.1% had <5 years of professional experience. More than half worked in government hospitals (54.5%), followed by university or academic settings (27.3%) and the private sector (18.2%). The sample had strong recognition of the medical value of stem cell donation but weaker legal, institutional, and practical readiness. Almost all physicians (96.4%) rated stem cell donation as highly important or very important for contemporary medical treatment. However, this strong clinical recognition was not matched by familiarity with legal and regulatory frameworks. Approximately 67.3% reported limited or no familiarity with the legal frameworks governing stem cell donation in GCC countries. Institutional support was also perceived as insufficient. Only 12.7% considered current support mechanisms adequate, 36.4% viewed support as inadequate or absent, and 50.9% reported only limited support. Willingness to donate among physicians was also context-dependent, with 34.5% definitely willing to donate stem cells after death and 56.4% being hesitant or undecided. Willingness was higher in the case of living donation to a family member, with 54.5% willing without reservation and 32.7% willing under certain conditions. The most frequently reported reason for hesitation was lack of adequate information (30.4%), followed by religious concerns (21.8%) and fear of health risks (18.2%). The results also revealed limited clinical exposure and training. Only 18.2% had direct experience with stem cell therapy patients, and only 9.1% had direct experience with stem cell donors. More than half of physicians (58.2%) reported observing challenges in the current stem cell donation system. Although 61.8% were aware of national donation programs, 38.2% remained unaware. Training was also a major weakness, with 69.1% rating existing training programs as inadequate or nonexistent. Physicians preferred practical workshops and hands-on training (60.0%), integration into medical curricula (54.5%), and collaboration with religious authorities (30.9%) as strategies for improving medical-sector awareness. Regarding public awareness, physicians recommended mass media campaigns (61.8%), education in schools and universities (60.0%), and community-based events (40.0%). Their policy preferences also showed caution toward presumed consent. Nearly half of physicians (49.1%) opposed or strongly opposed an opt-out system, 30.9% supported it, and 20.0% were neutral. This finding suggested that explicit consent remains more aligned with the ethical and cultural expectations of the surveyed physicians.

Cross-cutting pattern
Across both groups, the findings showed a consistent gap between general acceptance and practical readiness. Community participants and physicians both recognized the value of stem cell donation, particularly when connected to saving lives and supporting family members. However, this recognition was weakened by lack of information, religious uncertainty, limited legal awareness, and insufficient institutional communication. The findings also showed stronger support for explicit consent than presumed consent, suggesting that culturally sensitive opt-in systems may be more appropriate in the GCC context than a shift toward opt-out policies.

Discussion and Conclusions
The findings of this study show that stem cell donation in the GCC context is shaped less by outright rejection and more by a gap between positive recognition and practical readiness. Among community participants, general awareness was relatively visible, yet sufficient knowledge was limited. This finding was reflected in weak understanding of donor eligibility, low registration in donation programs, and uncertainty about religious rulings. The fact that only a small proportion of participants were already registered and more than half were unaware of registration programs indicated that the main challenge was not only attitudinal but also informational and institutional. Similarly, the preference for reliable medical information and clear religious guidance showed that potential donors require reassurance from both health care and religious authorities before moving from general acceptance to actual participation. The physician findings revealed a parallel challenge at the professional level. Physicians strongly recognized the therapeutic importance of stem cell donation, but many reported limited familiarity with legal and regulatory frameworks, inadequate institutional support, and insufficient training. This is a significant finding because physicians are expected to guide patients, explain risks, address concerns, and support donation systems. If physicians themselves are uncertain about legal requirements or lack structured institutional support, public education efforts may remain fragmented. The low level of direct clinical experience with stem cell donors and the perceived inadequacy of training further suggested that professional preparation must become a central part of any national or regional strategy for improving stem cell donation. Religious considerations should be interpreted carefully. In both community and physician responses, religious concern appeared as a need for clarification rather than a fixed barrier. This finding was consistent with the Islamic jurisprudential framework discussed earlier, which generally permits stem cell donation when the source is lawful, informed consent is obtained, harm is avoided, human dignity is protected, and commercialization is prohibited. Therefore, policy efforts should not treat religion as an obstacle. Instead, policy efforts should involve recognized religious authorities in producing accessible, clear, and medically informed guidance. Such guidance should be communicated through hospitals, universities, mosques, public campaigns, and official digital platforms. The results also suggested caution regarding presumed consent. Both community members and physicians showed limited support for an opt-out system, with many respondents either neutral or opposed. In the GCC context, where bodily integrity, family consultation, religious assurance, and explicit consent carry strong ethical and cultural significance, strengthening opt-in systems appears more appropriate than shifting directly toward presumed consent. A culturally sensitive opt-in model should include simple registration mechanisms, transparent legal guarantees, donor protection, noncommercialization, medical counseling, and public access to religious rulings. This study had some limitations. The use of convenience sampling and the relatively small sample size limited the generalizability of the findings. The study also relied on self-reported questionnaire data, which may not fully capture actual donation behavior. Nevertheless, the inclusion of both community and physician perspectives provides a useful exploratory picture of the social, professional, legal, and religious factors shaping stem cell donation in the GCC. Future research should use larger and more representative samples, include qualitative interviews with donors, patients, religious scholars, and policymakers, and examine how targeted educational or religious-communication interventions influence registration behavior over time. In conclusion, stem cell donation in the Gulf is medically valuable, ethically supportable, and jurisprudentially permissible when governed by clear safeguards. However, the findings showed that awareness alone is insufficient. Improving donation outcomes requires coordinated action across health care institutions, legal authorities, religious bodies, and educational platforms. The most practical path forward is to strengthen explicit consent systems through reliable public education, physician training, clear fatwas, transparent legal communication, and accessible registration pathways. Such an approach can transform general approval into informed participation while respecting the religious, ethical, and cultural foundations of Gulf societies.