Overcoming barriers and enhancing strategies in organ transplantation systems: a systematic review.

Abstract

Background: 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."

Aim: This systematic review aimed to identify key barriers to organ donation and evaluate strategies to improve donation rates.

Methods: 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.

Results: 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%.

Conclusion: 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.