The impact of social environment and educational level on public knowledge and attitudes towards organ donation: Can we do better?

Background. For many patients with end-stage disease, organ transplant often provides the only chance for survival. Organ donation (OD) is affected by legislation, cultural and ethnic background, and knowledge and attitudes play a crucial role in promoting that concept. The present study aimed to assess differences in education level, perception, and willingness towards OD among Bosnian immigrants living in Sweden and respondents living in Bosnia and Herzegovina. Study design. We performed a quantitative cross-sectional study using a self-administered questionnaire among 204 participants. Methods. The questionnaire provided demographic characteristics, information about opinions, awareness, and knowledge on the donation process and religious approach to the subject, willingness to donate/receive organs, and possession of a donor card. Results. All respondents supported OD, regardless of their education level. Only 2% of university-educated individuals from Bosnia and Herzegovina claimed to be donor card owners (p<0.001). Most of the university-educated respondents in Sweden, compared to Bosnia and Herzegovina, agreed that OD is needed and should be promoted (73.8% vs. 46.9%, p=0.007), opposite to the non-university-educated (51.4% vs. 66.0%, p=0.024). University-educated respondents stated that the donor card was informative enough (p=0.014) and considered self-perceived knowledge about OD to be sufficient or excellent (p<0.001). Most respondents were married and employed, practicing Muslims. Most of non-university-educated respondents from both countries believe their religion does not oppose OD (p=0.032). However, university-educated individuals strongly believe that OD does not have to be within the same religious group (p=0.016), while other participants did not have a definitive opinion. Conclusions. Public behavior towards OD is affected by the social environment and the educational level. The study highlights the importance of achieving a suitable social climate for donation. Also, it suggests that more efforts are needed to harvest the benefits of the substantial support for OD among the Bosnian population.