Trust in Organ Allocation Systems and Attitudes Toward Organ Donation Among Patients With End-Stage Renal Disease and Their Relatives: A Cross-Sectional Study

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BACKGROUND: Trust in healthcare systems is an important factor in patient decision-making and attitudes toward organ donation. OBJECTIVE: This study aims to examine the association between trust in organ allocation systems and attitudes toward organ donation, willingness to donate, knowledge, and concerns regarding fairness and transparency among patients with end-stage renal disease (ESRD) and their relatives. MATERIALS AND METHODS: A cross-sectional questionnaire-based study was conducted between December 2020 and September 2021 at two tertiary healthcare centers in Greece. Participants were recruited from dialysis units and outpatient nephrology clinics. A total of 178 individuals participated, including 104 patients with ESRD and 74 first-degree relatives. Patients and relatives were analyzed as independent groups. The questionnaire was adapted from previously published studies assessing attitudes toward organ donation, trust in healthcare systems, and transplantation-related decision-making. The instrument was reviewed for content relevance, pilot-tested before administration, and revised for clarity, although it was not formally validated. Data were collected through researcher-administered structured interviews. The questionnaire assessed trust in organ allocation systems, attitudes toward organ donation, willingness to donate, knowledge, and demographic characteristics. Higher education was defined as completion of post-secondary, university, or postgraduate education. Participants responding "no" to the question "Do you trust the organ allocation system?" were classified as having limited trust. Continuous variables are presented as mean ± standard deviation, and categorical variables as frequencies and percentages. Associations between categorical variables were assessed using chi-square tests. No substantial missing data were identified, and all completed questionnaires were included in the analysis. No adjustment for multiple comparisons was performed because of the exploratory nature of the study. Data were analyzed using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.), and statistical significance was set at p < 0.05. RESULTS: A total of 46% of participants reported limited trust in organ allocation systems. Lower trust was significantly associated with reduced willingness to donate organs (p = 0.02) and increased concerns regarding fairness and transparency (p = 0.01). Relatives reported lower levels of trust than patients (52% vs. 41%, p = 0.04). CONCLUSIONS: Trust in organ allocation systems was closely associated with attitudes toward organ donation and willingness among patients with ESRD and their relatives. Relatives reported lower levels of trust in organ allocation systems than patients did. Strengthening transparency, communication, and institutional credibility may be associated with greater willingness to donate and improved engagement with transplantation systems. These findings may help inform trust-based strategies and policy interventions aimed at improving organ donation systems.

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