Informing national policy: Healthcare workers' readiness for a deceased donor kidney transplant program in Brunei...

Brunei Darussalam currently lacks a deceased donor kidney transplant (DDKT) program, and its establishment in a small population poses challenges related to limited expertise and community misconceptions. Healthcare workers (HCWs), as the operational backbone of any transplant service, are central to translating policy into practice and guiding patient understanding. Assessing their perceptions is essential for gauging system readiness and informing strategies for future program development.

To explore HCWs' views on initiating a DDKT program, with specific focus on knowledge of kidney disease and attitudes toward deceased organ donation, opt-in donor card policy and transplant commercialization.

This was a questionnaire-based knowledge, attitude and practice study conducted at the main tertiary hospital in Brunei Darussalam. Statistical analyses included bivariate tests for categorical variables and multivariable logistic regression to identify factors associated with supportive or non-supportive attitudes towards DDKT.

A total of 370 HCWs participated in the study, with a female predominance (76%), comprising 58 doctors, 271 nurses, and 41 allied health professionals. Overall, 61% of respondents demonstrated high knowledge, while 39% had low knowledge. Regarding attitudes toward DDKT, 44% agreed, 12% disagreed, and 45% remained neutral. An opt-in donor card system was favored by 54%, while 35% were neutral and 11% disagreed. Attitudes towards transplant commercialization showed little variation, with 21% expressing acceptance, 45% neutrality, and 33% disagreement. Islamic religion, Malay ethnicity, nursing profession, lower knowledge level, female sex, and unawareness of fatwa were significantly associated with disagreement towards both DDKT and the donor card system (all P < 0.05). In multivariable logistic regression analysis, profession [adjusted odds ratio (aOR) = 4.54], religion (aOR = 7.34), education level (aOR = 4.11) and knowledge status (aOR = 1.88) remained independently associated with disapproval of DDKT.

Among HCWs in Brunei Darussalam, support for a DDKT program outweighs opposition, although a sizeable proportion remain undecided. Notably, some view commercialized transplantation as a potential means to address donor shortages, signaling ethical and policy concerns. These findings underscore the need to address knowledge gaps, enhance educational exposure, and clarify contextual issues to inform the development of a national DDKT program.