Level of Egyptians’ awareness and acceptance of organ donation legislation: a cross sectional study

Community perspectives on organ donation legislation, aligned with ethical and medical standards, shape the trajectory of donation practices. This study assessed public awareness and acceptance levels of the seven key articles governing organ donation under Egyptian law, focusing on how these perceptions influence willingness to donate. And identified the demographic and socioeconomic determinants. The study explored the relationship between awareness and willingness. It analyzed public perceptions of highly visible and lesser-known legal articles to identify disparities in understanding and acceptance. A cross-sectional study was conducted among 2743 participants aged 20–70 years, focusing on seven legal articles covering aspects such as donation eligibility, death verification, non-relative donations, government-funded transplants for the underprivileged, living donor restrictions, penalties for illegal transplants, and severe punishments for unauthorized procedures. Awareness and acceptance of 4–6 articles were reported by 36.9% and 43.7% of participants respectively. The highest awareness for state-funded transplants and the greatest acceptance for cross-national donation eligibility were observed. Factors influencing awareness included individuals aged (≤ 25 years, educated individuals and Group D participants. Willingness to donate, expressed by 78.4% of participants, correlated positively with awareness (OR = 6.48) and acceptance (OR = 9.69) of all seven articles (p < 0.001). Logistic regression model showed that higher awareness and acceptance increased willingness, while higher socioeconomic status (OR = 0.22 for Group A, p < 0.001) reduced it. Disparities in awareness and acceptance across different demographics and specific legal provisions highlight areas for targeted interventions. Addressing public skepticism about state-funded transplants and improving awareness of niche laws, such as cross-national donations, can enhance trust and participation in organ donation programs, thereby enhancing community support for ethical donation practices.