Comparative insights into posthumous organ donation attitudes in chronically ill and healthy Egyptians

Organ transplantation is a life-saving intervention, yet a persistent global organ shortage threatens patient survival. In Egypt, cultural, religious, and legal factors significantly influence donation willingness, contributing to persistently low consent rates. This study aimed to: (1) compare attitudes toward posthumous organ donation between patients with chronic illness and healthy individuals; (2) assess their preferences for eleven distinct consent models; and (3) evaluate awareness of Egyptian organ donation laws and how this and key socio-demographic predictors influence willingness to donate. This cross-sectional study included 6,000 participants (3,000 patients and 3,000 healthy individuals) from two Egyptian governorates. Participants were selected through stratified random sampling. Structured interviews and self-administered questionnaires collected data on socio-demographics, donation knowledge, and consent preferences. Participants ranked eleven consent models and assessed their awareness of key Egyptian organ donation laws. Patients exhibited a significantly higher willingness to donate posthumously (91%) compared to healthy individuals (60%) (p < 0.01). Written consent was preferred over verbal consent in both groups (75.2% vs. 70.1%, p < 0.001), emphasizing the importance of formal documentation. Incentivized donation was more favored by patients (59.6%) than healthy participants (54.7%) (p = 0.001), indicating incentives could enhance participation. Among patients, chronic illness was the primary motivator for donation, rendering socio-demographic variables less relevant. However, logistic regression identified key predictors among healthy participants. Participants aged 45-65 years were significantly less willing to donate than those over 65 years (AOR = 0.41, p = 0.01). Those in education (AOR = 2.07, p = 0.006) and manual workers (AOR = 1.94, p = 0.004) were more likely to donate than the unemployed. Higher socioeconomic status (C1/C2 and A/B) was associated with lower donation willingness than the lowest SES (D) (AOR = 0.34, 0.31, p < 0.001). Greater legal awareness was significantly associated with higher willingness to donate (p < 0.001). Chronic illness enhances donation willingness independent of socio-demographics. Health authorities should implement adaptive consent frameworks to enhance organ donation rates in Egypt, including simplified, surrogate-inclusive models for patients. Structured legal education programs for the general public to address knowledge gaps are recommended.