Knowledge and attitudes toward organ donation and transplantation among medical students in Greece: A cross-sectional survey

Table 1 Baseline characteristics of the study population, n (%)/mean ± SD

Baseline characteristics	Categories
Gender	Male	178 (31.7)
	Female	384 (68.3)
Age	Not applicable	21.5 ± 2.4
University	National and Kapodistrian University of Athens	75 (13.4)
	Aristotle University of Thessaloniki	163 (29.0)
	University of Ioannina	132 (23.5)
	University of Patras	41 (7.3)
	University of Crete (Heraklion)	45 (8.0)
	University of Thessaly (Larissa)	30 (5.3)
	Democritus University of Thrace	76 (13.5)
Place of permanent residence	City with > 100000 inhabitants (large city)	310 (55.2)
	City with < 100000 inhabitants (small city)	153 (27.2)
	Rural area	99 (17.6)
Year of study	1st-3rd (preclinical)	225 (40)
	4th-6th (clinical)	337 (60)
Grades	Good (5.00-6.49)	25 (4.5)
	Very good (6.50-8.49)	331 (58.8)
	Excellent (8.50-10)	111 (19.8)
	No grades assigned yet	95 (16.9)
Preferred specialty	Surgical	150 (26.7)
	Non-surgical	154 (27.4)
	Undecided	258 (45.9)
Regular blood donation	Yes	212 (37.7)
	No	350 (62.3)

No grades assigned yet: 1^st year medical students. Undecided: Students who have not yet decided on their intended specialty.

Table 2 Responses of medical students to attitude-related items of the questionnaire

Question	Category	n (%)
Relative who has undergone organ transplantation or is waiting for a compatible graft	Yes	119 (21.2)
	No	443 (78.8)
Discussing organ donation and transplantation with family and friends	Yes	378 (67.3)
	No	184 (32.7)
Willingness to donate after death	Yes	356 (63.4)
	No	206 (36.6)
Possessing a donor card (registered donor)	Yes	46 (8.2)
	No	516 (91.8)
Willingness to become a living organ donor	Yes	534 (95.0)
	No	28 (5.0)
Preference for a specific recipient among medical students willing to become living organ donors (leave blank if you would consent to become a donor regardless of your relationship with the recipient/unconditionally)	A close family member (e.g., parent, sibling, spouse, grandparent etc.)	312 (79.0)
	Own child	63 (16.0)
	Child regardless of relationship	12 (3.0)
	A close friend but not family	8 (2.0)
	Conditional donation to specific recipients	395 (74.0)
	No preference (unconditional)	139 (26.0)
Preference for type of graft for potential own needs	Living-donor graft	321 (57.1)
	Deceased-donor graft	241 (42.9)
Perceived efficiency of HTO’s efforts to promote organ donation	Yes	196 (34.9)
	No	366 (65.1)
Medical student’s role in promoting organ donation and transplantation in Greece	Yes	488 (86.8)
	No	74 (13.2)
Implementation of mandatory transplant course in medical curriculum	Yes	388 (69.0)
	No	174 (31.0)
Implementation of modern technologies would expand the donor pool in Greece	Yes	475 (84.5)
	No	87 (15.5)

HTO: Hellenic Transplant Organization.

Table 3 Results of logistic regression analyses examining factors associated with knowledge and attitude items of the questionnaire

Predictors	Dependent variables/outcomes [OR (95%CI), unadjusted P value, adjusted P value]
Independent variables	Willingness to donate after death (yes vs no)	Willingness to become a living organ donor (yes vs no)	Donor card possession (yes vs no)	Correct knowledge of deceased donor organs (correct vs wrong)	Correct knowledge of living donor organs (correct vs wrong)	Perceived quality of graft per donor type (living is better vs no difference)	Perceived sufficiency of HTO efforts (yes vs no)
Residence (big city vs rural)	0.82 (0.49-1.34), P = 0.43, adjusted P = 0.77	0.78 (0.46-1.33), P = 0.36, adjusted P = 0.81	1.55 (0.62-4.49), P = 0.38, adjusted P = 0.77	0.94 (0.49-1.86), P = 0.84, adjusted P = 0.95	1.02 (0.63-1.63), P = 0.94, adjusted P = 0.96	1.28 (0.67-2.44), P = 0.45, adjusted P = 0.45	1.04 (0.63-1.73), P = 0.89, adjusted P = 0.95
Residence (small city vs rural)	0.91 (0.52-1.59), P = 0.75, adjusted P = 0.93	1.04 (0.58-1.88), P = 0.89, adjusted P = 0.35	0.97 (0.31-3.22), P = 0.96, adjusted P = 0.96	0.81 (0.37-1.76), P = 0.58, adjusted P = 0.88	0.79 (0.47-1.34), P = 0.39, adjusted P = 0.77	0.94 (0.45-1.96), P = 0.87, adjusted P = 0.87	1.16 (0.66-2.03), P = 0.61, adjusted P = 0.89
Semester (clinical vs preclinical)	1.54 (1.05-2.62), P = 0.028, adjusted P = 0.16	0.68 (0.45-1.05), P = 0.80, adjusted P = 0.26	1.83 (0.76-4.89), P = 0.20, adjusted P = 0.64	1.14 (0.66-2.02), P = 0.64, adjusted P = 0.90	1.20 (0.83-1.76), P = 0.32 adjusted P = 0.77	1.54 (0.90-2.65), P = 0.11, adjusted P = 0.11	0.96 (0.65-1.43), P = 0.84, adjusted P = 0.95
Specialty preference (surgical vs non-surgical)	0.92 (0.56-1.52), P = 0.75, adjusted P = 0.93	1.14 (0.65-2.00), P = 0.66, adjusted P = 0.82	0.48 (0.20-1.11), P = 0.092, adjusted P = 0.38	0.88 (0.44-1.73), P = 0.70 adjusted P = 0.93	0.79 (0.49-1.28), P = 0.34, adjusted P = 0.77	2.15 (1.09-4.22), P = 0.028, adjusted P = 0.027	0.58 (0.36-0.94), P = 0.027, adjusted P = 0.16
Discussion with friends and family (yes vs no)	2.38 (1.64-3.47), P = 5.94 × 10-6, adjusted P < 0.001	0.77 (0.51-1.18), P = 0.24, adjusted P = 0.86	3.93 (1.49-13.59), P = 0.012, adjusted P = 0.10	1.17 (0.67-2.09), P = 0.59, adjusted P = 0.88	1.25 (0.87-1.82), P = 0.23, adjusted P = 0.64	0.72 (0.42-1.22), P = 0.22, adjusted P = 0.22	1.19 (0.81-1.78), P = 0.38, adjusted P = 0.77
Relative who has undergone organ transplantation or is waiting for a compatible graft (yes vs no)	0.88 (0.57-1.38), 0.59, adjusted P = 0.88	1.65 (1.03-2.64), P = 0.038, adjusted P = 0.26	0.77 (0.32-1.69), P = 0.53, adjusted P = 0.88	1.33 (0.72-2.35), P = 0.34, adjusted P = 0.77	1.10 (0.71-1.70), P = 0.68, adjusted P = 0.92	1.01 (0.55-1.87), P = 0.97, adjusted P = 0.97	0.85 (0.53-1.32), P = 0.47, adjusted P = 0.81
Blood donation (yes vs no)	1.40 (0.96-2.06), 0.082, adjusted P = 0.38	1.23 (0.82-1.86), P = 0.32, adjusted P = 0.55	1.82 (0.93-3.62), P = 0.084, adjusted P = 0.38	1.24 (0.73-2.07), P = 0.42, adjusted P = 0.77	1.06 (0.73-1.52), P = 0.77, adjusted P = 0.93	0.94 (0.57-1.55), P = 0.80, adjusted P = 0.80	0.61 (0.41-0.89), P = 0.012, adjusted P = 0.10
Acknowledgment of HTO (yes vs no)	1.40 (0.88-2.25), 0.16, adjusted P = 0.59	1.69 (1.05-2.74), P = 0.032, adjusted P = 0.50	6.60 (3.25-13.91), P = 3.03 × 10-7, adjusted P < 0.001	1.44 (0.80-2.55), P = 0.23, adjusted P = 0.64	1.26 (0.82-1.98), P = 0.30, adjusted P = 0.77	1.63 (0.92-2.88), P = 0.093, adjusted P = 0.094	2.21 (1.43-3.41), P = 0.0034, adjusted P = 0.01

Big city: City with over 100000 inhabitants, small city: City with less than 100000 inhabitants. OR: Odds ratio; 95%CI: 95% confidence interval; HTO: Hellenic Transplant Organization.

Table 4 Overview of the future directions with corresponding implementation recommendations

Domain	Action: Future perspectives
Educational	Introduction of transplantation as a mandatory module in medical curricula: (1) Longitudinal beginning in the preclinical years and reinforced during clinical years; and (2) Cover ethical principles, the procedural and legislative framework of organ donation, and the role of national structures in the field
	Adoption of active learning approaches: (1) Case-based teaching; (2) Critical appraisal of the transplantation literature; and (3) Simulated graft allocation and recipient prioritization
	Clinical immersion of students: Structured, direct observation of donor and candidate evaluation, allocation, and transplant care
Institutional	Strengthening the HTO’s visibility and credibility: (1) Establish a student advisory council with representatives from every national medical school; (2) Give students firsthand exposure to how the organization operates; and (3) Promote transparency and leadership
	Modernizing donor registration: Build digital registration into the systems students already use, such as university portals, student ID systems, medical student associations, and national electronic health records
Student-centered	Encouraging peer-led initiatives: (1) Support peer-led educational and research initiatives that rely on direct conversation between peers; and (2) Conferences and targeted campaigns for medical students
	Promoting direct interaction with living donors and organ recipients: Testimonies from living donors and transplant recipients, at conferences or university events
	Technological tools to sustain engagement and deepen understanding: (1) Interactive learning platforms; (2) Mobile applications; and (3) Virtual reality simulations of transplant procedures

HTO: Hellenic Transplant Organization; ID: Identification.