Knowledge, attitudes, and practices of organ, tissue, and cell donation in Nicaragua

Organ donation and transplantation are essential for improving the quality of life of people with organ failure due to chronic diseases (e.g., chronic kidney disease) or irreparable organ damage from accidents. In Nicaragua, chronic kidney disease of unknown etiology (CKDu) has emerged as a significant public health challenge, disproportionally affecting young agricultural workers and leading to premature deaths. Despite enactment of Law 847 in 2013, which regulates organ donations and transplantation, Nicaragua faces critical challenges, including lack of awareness, inadequate infrastructure, and limited public dissemination on the value of organ donation leading to an increasing number of patients on waiting lists. To address these gaps, we conducted an online cross-sectional survey to assess the knowledge, attitudes, and practices (KAP) regarding organ donation and transplantation in Nicaragua, a lower-middle-income country. We conducted an online cross-sectional survey among 4,407 Nicaraguan residents aged 18 and above from all 15 departments and two regions between November 2022 and February 2023. Most participants were women (60.3%), people aged 18-35 years (79.9%), and residents in urban areas (62.8%). The findings revealed that only 28.6% had good knowledge regarding organ and tissue donation and transplantation, 91.9% expressed positive attitudes toward organ and tissue donation, being willing to donate regardless of religious believes (88.5%) or personal health conditions (90.0%). About 72.6% engaged in donation-related behaviors. Men, those with higher education, and unemployed participants showed greater adherence to these practices. In summary, while Nicaraguans show positive attitudes towards organ and tissue donation and transplantation, significant knowledge and supply-demand gaps persist. Targeted educational campaigns and infrastructure development are urgently needed to address these gaps, enhance public awareness, and promote organ donation, particularly in the context of CKDu´s burden on public health.