Evaluation of the Knowledge and Opinions of Academicians and Students of the Faculties of Medicine, Nursing, Theology, and Law on Organ Donation: A Cross-Sectional Study in Turkey

Organ transplantation stands as a critical therapeutic solution for individuals suffering from end-stage organ failure. Advances in surgical techniques and immunosuppressive therapies have significantly improved graft survival and patient outcomes. However, the global organ shortage remains a pressing concern, with a growing discrepancy between the number of patients on waiting lists and the availability of donor organs [1]. In many developing countries, this gap is particularly pronounced. Despite nationwide awareness campaigns and increasing public discourse, actual organ donor registration rates remain low, and cadaveric donation levels are consistently reported below the European average according to the International Registry in Organ Donation and Transplantation (IRODaT). This highlights that awareness alone is insufficient; social, cultural, ethical, and religious dimensions must also be addressed [2].

Attitudes toward organ donation are strongly influenced by individual beliefs and societal values. In countries where religious convictions and moral perspectives play a significant role in shaping public behavior, the involvement of key opinion leaders— especially from the medical, legal, and theological domains— is essential in promoting accurate knowledge and acceptance of organ donation [3]. Academicians and students in faculties such as medicine, nursing, theology, and law not only represent future professionals but also serve as societal influencers. Their perceptions and knowledge directly affect both clinical practices and public discourse. However, comparative data on their attitudes toward organ donation remain limited [4,5]. This study aims to evaluate and compare the knowledge, attitudes, and opinions of academicians and final-year students from the faculties of medicine, nursing, theology, and law. By identifying disciplinespecific gaps and misconceptions, the study seeks to inform the design of targeted educational and policy interventions to improve organ donation rates at the national level.

Study Design and Setting

This descriptive and cross-sectional study was conducted between September 2021 and August 2022 at the University, a large public institution. The study aimed to assess the knowledge and attitudes of faculty members and final-year undergraduate students from the Faculties of Medicine, Nursing, Theology, and Law regarding organ donation and transplantation. These four faculties were selected based on their potential influence on public perceptions and their unique disciplinary roles. Medical and nursing faculties are directly involved in organ procurement, transplantation, and health education. Theology faculties contribute to the religious discourse surrounding the permissibility and ethics of organ donation, while law faculties inform the legislative and policy frameworks that regulate transplantation practices. Including these disciplines enabled a comprehensive evaluation of diverse perspectives influencing organ donation.

Study Population and Sampling

The study population comprised 1787 individuals, including 1325 final-year undergraduate students and 462 academic staff. The student population was distributed as follows: Faculty of Medicine (n=288), Faculty of Nursing (n=290), Faculty of Theology (n=400), and Faculty of Law (n=347). Academic staff included 259 from Medicine, 64 from Nursing, 91 from Theology, and 48 from Law. A total of 481 participants were included in the final sample, consisting of 326 students and 155 academic staff members. Participants were selected using stratified cluster sampling, where each faculty represented a separate stratum. Sampling was performed proportionally within each stratum to ensure adequate representation of both students and academic staff across faculties. A priori power analysis was conducted using G*Power 3.1 software to ensure adequate sample size. Based on a medium effect size (w = 0.30), alpha level of 0.05, and 95% confidence level, the minimum required sample size was determined to be 350 participants. With 481 respondents, the study achieved sufficient statistical power (power = 0.95).

Data Collection Instrument

Data were collected using a structured questionnaire developed by the researchers [4,6-10]. The instrument was based on an extensive literature review and feedback from subject matter experts in medical ethics, theology, public health, and health education. The questionnaire comprised three main sections:
a) Socio-demographic characteristics (e.g., age, gender, marital status, economic status, academic position),
b) Knowledge and awareness related to organ donation and transplantation,
c) Attitudes and beliefs regarding the medical, legal, religious, and ethical dimensions of organ donation./p>

No standardized measurement tool was employed, and internal consistency analysis (e.g., Cronbach’s alpha) was not conducted since the objective was to analyze categorical variables rather than to generate scale scores. Content validity was ensured through expert review by five academicians in relevant disciplines.

Data Collection Procedure

The questionnaire was distributed electronically via Google Forms. Participation was voluntary, and informed consent was obtained from all participants prior to data collection. Responses were anonymous and confidential. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and received approval from the Ethics Committee.

Data Analysis

The data were analyzed using IBM SPSS Statistics Version 24. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participants’ characteristics and responses. In addition, chi-square tests (χ2) were applied to examine statistically significant differences between groups (e.g., among faculties). A p-value of <0.05 was considered statistically significant.

A total of 481 individuals participated in the study, including 155 academic staff members and 326 final-year undergraduate students from the Faculties of Medicine, Nursing, Theology, and Law at the University.

Demographic Characteristics

The mean age of the academic staff was 35.79±9.51 years, and 57.4% were female. Of the academicians, 67.7% were married and 52.3% described their economic status as moderate. Faculty distribution was as follows: Medicine (35.5%), Nursing (30.3%), Law (23.2%), and Theology (11%). Regarding academic positions, 38.7% were research assistants, 8.4% lecturers, and 52.9% faculty members; in terms of academic degree, 39.4% held research assistant status, 36.2% were assistant professors, and 12.3% each were professors and associate professors. Nearly one-third (33.5%) had been working for less than five years (Table 1). Among students, the average age was 23.29±4.35 years. Females made up 67.5% of the sample, and 92.6% were single. Regarding perceived economic status, 72.1% reported poor, 14.4% good, and 13.5% moderate financial conditions. The distribution by faculty was as follows: Nursing (27.9%), Theology (27.3%), Medicine (23.6%), and Law (21.2%) (Table 2).

Table 1:Descriptive Characteristics of Academic Staff (n=155).

Table 2:Descriptive Characteristics of Students (n=326).

Organ Transplant Knowledge and Experience (Students)

Among students, the rate of those who had a relative who underwent organ transplantation differed significantly between faculties. The highest rate was observed among Theology students (16.9%), while medical students reported the lowest (1.3%) (p<0.05, Table 3). No significant difference was found between faculties regarding those with relatives waiting for transplantation. The rate of students who had received prior information about organ donation also varied significantly (p<0.05). Medical students had the highest rate (94.8%), whereas Nursing students had the lowest (73.6%). The most commonly cited sources were mass media platforms. Among Medical students, 49.3% reported learning via internet/TV/social media; this rate was 53.7% in Nursing, 33.3% in Theology, and 29.6% in Law (Table 3). Students who reported knowing how to donate organs also differed significantly across faculties (p<0.001), with 87.0% of medical students affirming this knowledge versus 58.4% in Theology. However, actual registration as organ donors did not show a statistically significant difference between faculties; the highest registration rate (11.7%) was still in the Faculty of Medicine (Table 3).

Table 3:Comparison of Students’ Opinions on Organ Transplantation by Departments.

*p<.05, **p<.001, ***Multiple answers were given, X2=Chi-Square Analysis

Attitudes Toward Organ Donation (Students)

Among students, willingness to donate organs significantly differed by faculty (χ2=37.296; p<0.001). The highest rate was observed in the Faculty of Medicine (81.8%), while the lowest was in Theology (42.7%) (Table 3). The most common motivation was altruism—“doing good and saving lives”—most frequently cited by Theology students (60.5%). Among those unwilling to donate, the most common deterrent was “not wanting the body to be physically altered,” reported by 71.4% of Law students, 35.7% of medical students, 23.5% of Theology students, and 20.5% of Nursing students (Table 3).

Perceptions of Medical, Religious, and Legal Appropriateness (Students)

Perceptions regarding the medical, religious, and legal appropriateness of organ transplantation significantly varied by faculty among students. The highest agreement that living donor transplantation is medically appropriate was in the Faculty of Medicine (97.4%) and the lowest in Theology (70.8%) (χ2=28.299; p<0.001). Similar trends were observed for religious (χ2=21.981; p<0.001) and legal (χ2=19.586; p<0.001) appropriateness (Table 4). For cadaveric transplantation, the highest agreement on medical appropriateness was again in Medicine (90.9%) and lowest in Theology (78.7%) (χ2=8.464; p<0.05). Only 62.9% of Theology students found cadaveric donation religiously appropriate (χ2=23.462; p<0.001) (Table 4).

Organ Transplant Knowledge and Experience (Academicians)

Among academicians, prior exposure to organ donation information significantly differed between faculties (p<0.001). Academicians in Medicine (90.9%) and Nursing (91.5%) reported the highest rates, while those in Theology (64.7%) and Law (63.9%) were lower (Table 5). The main sources of information were healthcare professionals and academic publications. Knowledge of the donation process also differed significantly (p<0.001), with 96.4% of medical faculty members affirming this knowledge versus 52.8% in Law. Completion of an official donation form also showed statistically significant variation, with Medicine at 30.9%, while Theology and Law were below 6% (Table 5).

Table 4:Comparison of Students’ Views on the Medical, Religious, and Legal Aspects of Organ Transplantation Across Faculties

*p<.05, **p<.001, X² = Chi-square test

Attitudes Toward Organ Donation (Academicians)

Willingness to donate organs significantly varied across faculties (χ2=8.083; p<0.05). While 80% of medical faculty members expressed willingness, this dropped to 47.1% among those in Theology (Table 5). The leading reason cited for willingness was the “vital importance of organ donation” (56.2%). Among those unwilling to donate, the primary reason was “concern about body integrity” (64.9%), reaching as high as 90% among Law faculty members (Table 5).

Table 5:Comparison of Faculty Members’ Opinions on Organ Transplantation According to Their Academic Departments.

*p<.05, **p<.001, ***Multiple responses were allowed, X² = Chi-square test

Perceptions of Medical, Religious, and Legal Appropriateness (Academicians)

Among academicians, living donor transplantation was found medically appropriate by 98.2% in Medicine and 97.9% in Nursing, but only 76.5% in Theology (χ2=13.566; p<0.05) (Table 6). Similarly, 96.4% of medical faculty members viewed it as religiously acceptable, compared to 70.6% in Theology (χ2=12.787; p<0.05). Legal appropriateness also differed significantly among faculties (χ2=11.574; p<0.05). Overall, both students and academicians perceived cadaveric transplantation as more acceptable across all three dimensions, though faculty members from Theology demonstrated more cautious attitudes (Tables 4&6).

Sociocultural and Ethical Attitudes

Participants’ sociocultural and ethical attitudes toward organ donation varied by faculty. Among students, 52.8% agreed that receiving an organ from a non-Muslim is religiously acceptable, while 76.1% were comfortable with donating their organs to a non-Muslim. This acceptance was highest among students from the Faculties of Medicine and Law, whereas Theology students showed more reservations (60.7%) (Table 4). Among academicians, 81.9% found it acceptable to receive organs from a non-Muslim and 76.1% were willing to donate to one. There was a statistically significant difference between faculties, with Theology faculty members expressing more cautious views (χ2=8.626; p<0.05) (Table 6). Most participants, both students and academicians, considered offering money or gifts to organ donors as inappropriate from both religious (above 70%) and medical (67%–75%) perspectives. However, legal acceptability varied across faculties and was less consistently agreed upon (Tables 4&6).

Intentions and Influences

Among students, 91.1% stated that they would accept an organ transplant if needed. Willingness to donate organs to close relatives (parents or siblings) was reported by 95.1% (Table 4). However, when asked about donating a relative’s organs after brain death, the rate dropped to 66.3%, with medical students showing the highest agreement at 83.1% (χ2=24.516; p<0.001). Knowledge distinguishing brain death from a vegetative state was held by 73% of students. Medical students had the highest accuracy (90.9%), while the lowest rate was found among Theology students (65.2%) (χ2=17.035; p<0.001). Notably, 46.1% of Theology students believed recovery from brain death was possible (χ2=41.396; p<0.001). Among academicians, 97.4% were willing to receive an organ if needed. While 98.1% were open to donating for close relatives, only 70.3% were willing to donate a relative’s organs after brain death (Table 6). This difference across faculties was statistically significant (χ2=6.518; p<0.05).

In terms of the influence of media (TV, films, social media, etc.), 50.2% of students believed it had a positive impact on public attitudes toward organ donation, while 46.5% of academicians agreed. Among the Theology faculty, 52.9% of academicians perceived no impact, indicating a notable divergence (χ2=18.925; p<0.001). In both groups, there was a strong preference for multidisciplinary education regarding organ donation, with support for joint education initiatives from health, law, and religious professionals. This view was supported by over 72% of students and more than 80% of academicians (Tables 4&6).

Table 6:Comparison of Academicians’ Views on the Medical, Religious, and Legal Aspects of Organ Transplantation by Faculty.

*p<.05, **p<.001, X² = Chi-Square Analysis

The Gap Between Knowledge and Behavior

One of the central findings of this study is the pronounced gap between participants’ self-reported knowledge about organ donation and their actual donation behaviors. For instance, although 87% of medical students claimed to know how the organ donation process works, only 11.7% reported having filled out an official donation form. This discrepancy aligns with prior literature highlighting the disconnect between awareness and action in the context of organ donation [11,12]. These results underscore the need for behaviorally informed educational interventions that bridge this knowledge-behavior gap, rather than relying solely on informational campaigns.

Conceptual Misconceptions and Clinical Definitions

Despite high levels of perceived understanding, a significant number of both students (22.1%) and academic staff (52.2%) believed that recovery from brain death is possible. This misconception indicates that even participants who consider themselves well-informed may lack fundamental knowledge about key medical definitions. As emphasized by Skowronski et al., such conceptual confusion may erode public trust in organ donation systems, highlighting the critical need for clearer clinical communication and education regarding death and donation criteria [13].

Religious Perceptions and Inter-Faculty Variations

The study also revealed distinct variations between faculties, particularly regarding religious interpretation. Theology students not only demonstrated the highest rate of confusion about brain death (34.8%) but also had the lowest rate of formal donation registration (4.5%). These findings support those of Bulut [14] and Aykaş et al. [15], who noted that religious ambiguity can act as a barrier to donation. As such, targeted educational interventions that provide clear, theologically sound, and evidence-based information are especially needed for faculties of theology and law.

Sociocultural and Ethical Barriers

Across both participant groups, the most frequently cited reason for reluctance to donate was a desire to preserve bodily integrity post-mortem. This concern illustrates the deep-rooted sociocultural and spiritual significance attributed to the physical body, particularly after death [16]. These findings suggest that educational initiatives must go beyond cognitive instruction and incorporate value-based discussions that respectfully address emotional, cultural, and spiritual sensitivities.

Educational and Informational Approaches

A large proportion of participants expressed dissatisfaction with educational efforts led solely by healthcare professionals and instead advocated for interdisciplinary approaches that include religious leaders, legal experts, and medical staff. This aligns with findings by Bas-Sarmiento et al. [7], who demonstrated that multidisciplinary education significantly enhances comprehension and positively shapes attitudes toward organ donation. Integrating such models into university curricula may foster more holistic understanding and ethical reflection.

Analysis of Behavioral Intentions and Tendencies

Although over 95% of participants stated they would accept an organ transplant if needed, only 66.3% of students and 29.7% of academic staff expressed willingness to authorize the donation of a deceased relative’s organs. This suggests that while individuals may be altruistic regarding themselves, they become significantly more cautious when making decisions for others—a finding echoed in recent international studies. Liu et al. (2021) observed a similar disparity: 68.1% of individuals consented to donate their own organs, but only 51.8% would donate a family member’s [17]. This discrepancy is often attributed to “surrogate decision-making heuristics” and overconfidence—decision-makers feel sure they know what their relatives want, even without prior discussion. Recent literature highlights the role of cultural and relational autonomy—that is, how social norms and family dynamics influence end-of-life decisions. Alolod et al. [18] showed that individuals switch from individual autonomy to a relational autonomy framework when deciding for family members, emphasizing familial harmony over personal preference. This reflects the emotional and ethical complexity behind surrogate consent.

Moreover, frontline medical research [19] points out that family refusal remains a major obstacle in organ procurement; their findings suggest that intensive care families desire accurate and timely information but remain hesitant in decision-making. Together, these data indicate that educational initiatives not only need to provide factual knowledge but also address family dynamics, surrogate decision-making confidence, and culturally mediated hesitations. Future content should especially focus on encouraging family–relative discussions to reduce ambiguity and improve consent rates.

This study highlights critical insights into the knowledge, perceptions, and behavioral tendencies regarding organ donation among academicians and final-year students from four key faculties. Despite widespread awareness and generally positive attitudes, a clear disconnect remains between knowledge and actual donor registration, particularly among those expected to lead societal change such as medical and nursing professionals. The findings underscore the need for faculty-specific, culturally sensitive educational interventions that move beyond information delivery to address cognitive misconceptions, ethical hesitations, and religious uncertainties. The data further suggest that integrating interdisciplinary collaboration—particularly involving healthcare providers, legal experts, and religious authorities—can enhance trust and clarity in organ donation processes. By revealing discipline-based gaps and shared challenges, this study provides a foundation for the development of structured curricula and public health strategies that can promote informed, value-aligned decision-making. In doing so, it contributes to the broader national and international efforts to bridge the gap between organ donation awareness and action.

While this study offers valuable insights into the knowledge and attitudes toward organ donation among academicians and students from diverse disciplines, several limitations should be acknowledged. First, the study was conducted at a single university, which may limit generalizability; however, the inclusion of four distinct faculties—medicine, nursing, theology, and law—adds richness and interdisciplinary depth to the findings. Second, although chi-square tests were applied to assess group differences, the cross-sectional design does not allow for causal inferences. Nonetheless, the use of stratified sampling and a reasonably large sample size enhances internal validity and representativeness. Third, the data collection tool was researcher-developed rather than based on a previously validated instrument. However, it was rigorously reviewed by experts from relevant fields to ensure content validity and alignment with current academic discourse. Future studies may benefit from multi-center designs, validated instruments, and longitudinal approaches to assess behavioral changes following educational interventions. Despite its limitations, this study provides meaningful baseline data that can inform future educational strategies and policy development.

Conceptualization: Mehtap Kavurmaci (MK), Büşra Ceren Demirel Yildiz (BCDY), Mehtap Tan (MT)
Data curation: Büşra Ceren Demirel Yildiz (BCDY), İdris Yildiz (İY)
Formal analysis: Mehtap Kavurmaci (MK), İdris Yildiz (İY)
Funding acquisition: Mehtap Kavurmaci (MK)
Investigation: Mehtap Kavurmaci (MK), Büşra Ceren Demirel
Yildiz (BCDY), Aysenur Sariaslan (AS)
Methodology: Mehtap Kavurmaci (MK), Mehtap Tan (MT)
Project administration: Mehtap Kavurmaci (MK)
Resources: Büşra Ceren Demirel Yildiz (BCDY), Aysenur Sariaslan (AS), Ali Ihsan Pala (AIP)
Software: Büşra Ceren Demirel Yildiz (BCDY), İdris Yildiz (İY)
Supervision: Mehtap Kavurmaci (MK), Zekai Halici (ZH)
Validation: Mehtap Kavurmaci (MK), Gurkan Ozturk (GO)
Visualization: Mehtap Kavurmaci (MK), Büşra Ceren Demirel Yildiz (BCDY)
Writing – original draft: Mehtap Kavurmaci (MK), Büşra Ceren Demirel Yildiz (BCDY), İdris Yildiz (İY)
Writing – review & editing: Mehtap Kavurmaci (MK), Mehtap Tan (MT), Gurkan Ozturk (GO), Ali Ihsan Pala (AIP), Ozgur Temiz (OT), Zekai Halici (ZH), Büşra Ceren Demirel Yildiz (BCDY)

All ethical issues (including plagiarism, data fabrication, and double publication) have been completely observed by the authors. The study was approved by the Ethics Committee of Atatürk University.

The authors declare that there is no conflict of interest regarding this manuscript.

This study was supported by Atatürk University Scientific Research Projects Coordination Unit (BAP) under Project No: TCD- 2021-9370.

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