Organ donation in Saudi Arabia: a profile of public knowledge and behavior from an online survey

Despite advanced healthcare infrastructure and supportive policy, low donor availability remains the major barrier to organ transplantation in the Kingdom of Saudi Arabia (KSA). Multiple interlinked and complex factors, including psychosocial, cultural, and religious factors, are believed to influence organ donation behavior. The current study explored public knowledge, attitudes, and behavioral intentions toward organ donation in KSA to inform targeted interventions.

A cross-sectional online survey grounded in the Theory of Planned Behavior was administered nationwide between June and December 2022. Eligible participants were KSA residents aged ≥16 years who could read Arabic and provided consent. A convenience sampling method was used to recruit participants; incomplete responses (<80% of items) were excluded. The instrument assessed knowledge, attitudes, subjective norms, perceived behavioral control, and willingness to register as an organ donor.

Indecision about registering as an organ donor predominated across sociodemographic groups. Females reported higher willingness to register than males (10.4% vs. 8.7%) and lower refusal (10.2% vs. 13.6%), with a significant association (χ ² = 10.3, p = 0.006). Nationality was associated with willingness, with Saudi nationals showing higher willingness (χ ² = 13.8, p < 0.001). Occupation (χ ² = 20.3, p = 0.009) and income (χ ² = 17.3, p = 0.008) were also significantly associated with willingness, with non-working and some higher-income groups more often undecided. Overall, a favorable normative climate and substantial religious endorsement coexisted with gaps in specific knowledge and persistent ambivalence.

In KSA, supportive norms and religious approval are necessary but insufficient to translate positive attitudes into registration behavior. Reducing indecision will likely require sustained, targeted education that addresses misconceptions, clarifies the donation process, and leverages trusted religious and community channels.