# Comparative insights into posthumous organ donation attitudes in chronically ill and healthy Egyptians

## TL;DR

This study compares attitudes toward posthumous organ donation in chronically ill and healthy Egyptians, finding that patients are more willing to donate and that legal awareness and consent models significantly influence donation willingness.

## Contribution

The study provides novel insights into how chronic illness and socio-demographic factors influence organ donation attitudes and preferences in Egypt.

## Key findings

- Patients with chronic illness showed significantly higher willingness to donate (91%) compared to healthy individuals (60%).
- Written consent was preferred over verbal consent in both groups, highlighting the importance of formal documentation.
- Legal awareness was significantly associated with higher willingness to donate, suggesting the need for public education on organ donation laws.

## Abstract

Organ transplantation is a life-saving intervention, yet a persistent global organ shortage threatens patient survival. In Egypt, cultural, religious, and legal factors significantly influence donation willingness, contributing to persistently low consent rates. This study aimed to: (1) compare attitudes toward posthumous organ donation between patients with chronic illness and healthy individuals; (2) assess their preferences for eleven distinct consent models; and (3) evaluate awareness of Egyptian organ donation laws and how this and key socio-demographic predictors influence willingness to donate. This cross-sectional study included 6,000 participants (3,000 patients and 3,000 healthy individuals) from two Egyptian governorates. Participants were selected through stratified random sampling. Structured interviews and self-administered questionnaires collected data on socio-demographics, donation knowledge, and consent preferences. Participants ranked eleven consent models and assessed their awareness of key Egyptian organ donation laws. Patients exhibited a significantly higher willingness to donate posthumously (91%) compared to healthy individuals (60%) (p < 0.01). Written consent was preferred over verbal consent in both groups (75.2% vs. 70.1%, p < 0.001), emphasizing the importance of formal documentation. Incentivized donation was more favored by patients (59.6%) than healthy participants (54.7%) (p = 0.001), indicating incentives could enhance participation. Among patients, chronic illness was the primary motivator for donation, rendering socio-demographic variables less relevant. However, logistic regression identified key predictors among healthy participants. Participants aged 45–65 years were significantly less willing to donate than those over 65 years (AOR = 0.41, p = 0.01). Those in education (AOR = 2.07, p = 0.006) and manual workers (AOR = 1.94, p = 0.004) were more likely to donate than the unemployed. Higher socioeconomic status (C1/C2 and A/B) was associated with lower donation willingness than the lowest SES (D) (AOR = 0.34, 0.31, p < 0.001). Greater legal awareness was significantly associated with higher willingness to donate (p < 0.001). Chronic illness enhances donation willingness independent of socio-demographics. Health authorities should implement adaptive consent frameworks to enhance organ donation rates in Egypt, including simplified, surrogate-inclusive models for patients. Structured legal education programs for the general public to address knowledge gaps are recommended.