Systematic review of educational programs and system improvements for organ donation barriers

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Frontiers in Medicine Published May 23, 2026 Medically reviewed May 23, 2026 Study authors: Priya Sharma, Nipin Kalal, Nimarta Rana DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider combined educational and system improvements to address organ donation barriers.

This systematic review examines barriers to organ donation and strategies to improve donation rates across a global setting. The analysis includes data from 33 studies involving patients on waiting lists, people supporting organ donation, and healthcare professionals. Key outcomes assessed include awareness of relevant laws, misconceptions, lack of family support, fear of health complications, and healthcare professional donor card possession.

The review reports that only 11% of participants were aware of relevant laws, while up to 91% demonstrated poor awareness. Misconceptions were present in 38.8% of cases, and 58% reported a lack of family support. Additionally, 69% expressed fear of health complications, and 37.3% of healthcare professionals held donor cards. These figures highlight significant gaps in knowledge and trust within the current system.

Interventions included educational programs and a combined approach featuring culturally appropriate education alongside healthcare system improvements. Willingness to register increased from 12% to 68%, and knowledge improved from 36.4% to 88.5% with these strategies. The authors note that safety data, such as adverse events or discontinuations, were not reported in the source studies. Funding and conflicts of interest were also not reported.

The practice relevance emphasizes that bridging the gap between willingness and action requires a combined approach. This involves providing simple, culturally appropriate education about donation and improving healthcare systems to build trust. Such measures aim to reduce financial and practical burdens on donors, addressing the complex barriers identified in the global evidence base.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Organ transplantation is one of the major achievements of modern medicine, yet the global shortage of organs remains a serious challenge. This shortage increases mortality among patients on waiting lists. Although up to 80% of people support organ donation, far fewer register as donors, creating a clear “knowledge–action gap.” This systematic review aimed to identify key barriers to organ donation and evaluate strategies to improve donation rates. A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for peer-reviewed studies published in the last decade. Following PRISMA guidelines, 33 studies were included, covering randomized controlled trials, cross-sectional, and mixed-methods designs. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Barriers to organ donation were found to be complex and interconnected, involving social, psychological, and systemic factors. Lack of knowledge was the most common issue, with up to 91% reporting poor awareness and only 11% aware of relevant laws. Sociocultural and religious concerns also influenced decisions, with 38.8% reporting misconceptions and 58% lacking family support. Psychological barriers were significant, with 69% fearing health complications and expressing mistrust in the healthcare system. At the system level, despite general willingness, only 37.3% of healthcare professionals had donor cards. However, targeted interventions showed positive outcomes. Educational programs increased willingness to register from 12% to 68% and improved knowledge from 36.4% to 88.5%. The main barrier to organ donation is the gap between willingness and action, largely due to uncertainty and lack of understanding. Bridging this gap requires a combined approach: providing simple, culturally appropriate education about donation and improving healthcare systems to build trust and reduce financial and practical burdens on donors.