Public attitudes and preferences on organ donation and allocation in china: a cross-sectional study

This cross-sectional study aimed to examine public attitudes toward postmortem organ donation and allocation fairness preferences in China. To this end, an online survey was administered through the Wenjuanxing platform among adults aged ≥ 18 years (N = 895). Only 15.1% of respondents had decided to donate, whereas 74.1% remained undecided; nevertheless, 73.7% would accept a donated organ if needed. Reciprocity (76.0%), first-come-first-served (70.5%), and medical urgency (65.7%) were most frequently endorsed as fair allocation principles. In the full-sample logistic regression (N = 895), positive attitudes (odds ratio [OR] = 5.65, p < 0.001), higher knowledge (OR = 1.56, p < 0.001), and knowing someone who had donated or was considering donating (OR = 1.96, p = 0.013) predicted willingness to donate. Further, a conditional analysis among decision-makers (N = 232) revealed that married status (OR = 0.18, p = 0.007), religious beliefs (OR = 0.22, p = 0.020), and higher education (OR = 1.50, p = 0.024) significantly differentiated donors from non-donors. Collectively, these findings indicate that organ donation willingness in China remains low despite broadly positive attitudes. Knowledge deficits, procedural uncertainty, and family-centered decision-making norms impede commitment, thereby underscoring the need for enhancing public education and institutional transparency.