Results

The study sample comprised 2609 adults with a mean age of 30.87 ± 11.14 years and a modest female predominance (ratio of 1.34:1). The majority were Saudi nationals (94.5%). Geographically, nearly half of the participants resided in Makkah Province (47.8%), followed by Riyadh (23.6%). Educational levels were high, with only 0.3% reporting no formal education. Most participants held either a diploma or a bachelor's degree (68.7%), while 19.2% had a postgraduate qualification. Most participants (69.2%) were employed, where the remainder comprised students, retirees, housewives, and the unemployed (Table 1).

Characteristics | All n/Na (%)
Number of participants | 2609
Age in years | 
Mean (SD) | 30.87 (±11.14)
Range (Median) | 18–76 (27)
Gender | 
Female:male | 1.34:1
Nationality | 
KSA | 2460/2603 (94.51)
Other | 143/2603 (5.49)
Province of residence | 
Makkah | 1244/2604 (47.77)
Riyadh | 615/2604 (23.62)
Eastern | 315/2604 (12.10)
Al-Madinah | 147/2604 (5.65)
Al-Qassim | 90/2604 (3.46)
Assir | 68/2604 (2.61)
Other | 125/2604 (4.80)
Highest qualification | 
No formal education | 7/2591 (0.27)
School certificateb | 305/2591 (11.77)
Diploma/bachelor's degree | 1781/2591 (68.74)
Postgraduate degree | 498/2591 (19.22)
Employed | 
Noc | 800/2598 (30.79)
Yes | 1798/2598 (69.21)

Initial unadjusted analysis indicated consistently high support for ODAD across all demographic groups, with an overall support rate of 82.1%. Males reported lower support compared with females (79.9% vs. 83.9%; OR = 0.75, p < 0.05). Furthermore, 84.5% of the sample supported adding donation authorization to official documents. Despite the high overall support, only 5.5% of the total sample possessed a donor card, revealing a prominent willingness-to-commitment gap. No substantial differences in general support were observed by nationality, province of residence, education level, or employment status, where the support rates among these groups ranged from 81% to 83% (Table 2).

Characteristics | Heard of organ donation event | Heard about organ donation card | Support organ donation after death | Carrying an organ donation card | Support adding organ donation authorisation to official documents
n/Na (%) | OR (95% CI) | p | n/Na (%) | OR (95% CI) | p | n/Na (%) | OR (95% CI) | p | n/Na (%) | OR (95% CI) | p | n/Na (%) | OR (95% CI) | p
All |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 
All participants¶ | 1633/2607 (62.6) |  |  | 1467/2601 (56.4) |  |  | 2138/2604 (82.1) |  |  | 145/2607 (5.6) |  |  | 2192/2593 (84.5) |  | 
Sex |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 
Female | 984/1490 (66.0) | 1.0 (ref) |  | 901/1486 (60.6) | 1.0 (ref) |  | 1247/1487 (83.9) | 1.0 (ref) |  | 105/1490 (7.1) | 1.0 (ref) |  | 1279/1481 (86.4) | 1.0 (ref) | 
Male | 646/1114 (58.0) | 0.71 (0.60–0.83) | <0.001b | 565/1112 (50.8) | 0.67 (0.57–0.79) | <0.001b | 890/1114 (79.9) | 0.75 (0.62–0.94) | <0.05b | 40/1114 (3.6) | 0.49 (0.34–0.71) | <0.001b | 911/1109 (82.2) | 0.73 (0.59–0.90) | 0.003b
Nationality |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 
Other | 83/143 (58.0) | 1.0 (ref) |  | 61/143 (42.7) | 1.0 (ref) |  | 119/143 (83.20) | 1.0 (ref) |  | 5/143 (3.5) | 1.0 (ref) |  | 119/141 (84.4) | 1.0 (ref) | 
KSA | 1546/2458 (62.9) | 1.23 (0.87–1.73) | 0.24 | 1405/2452 (57.3) | 1.8 (1.28–2.54) | <0.001b | 2013/2455 (82.0) | 0.92 (0.59–1.44) | 0.711 | 140/2458 (5.7) | 1.67 (0.67–4.13) | 0.265 | 2068/2446 (84.6) | 1.01 (0.63–1.61) | 0.962
Province of residence |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 
Other | 858/1359 (63.1) | 1.0 (ref) |  | 799/1238 (53.7) | 1.0 (ref) |  | 1122/1356 (82.7) | 1.0 (ref) |  | 80/1360 (5.9) | 1.0 (ref) |  | 1130/1347 (83.9) | 1.0 (ref) | 
Makkah province | 773/1243 (62.2) | 0.96 (0.82–1.13) | 0.62 | 665/1358 (58.8) | 0.81 (0.70–0.95) | <0.01b | 1012/1243 (81.4) | 0.90 (0.75–1.12) | 0.378 | 65/1242 (5.2) | 0.88 (0.63–1.24) | 0.471 | 1057/1241 (85.2) | 1.10 (0.89–1.37) | 0.376
Postgraduate qualification |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 
No | 1278/2092 (61.1) | 1.0 (ref) |  | 1143/2087 (54.8) | 1.0 (ref) |  | 1717/2089 (82.2) | 1.0 (ref) |  | 99/2091 (4.7) | 1.0 (ref) |  | 1743/2079 (83.8) | 1.0 (ref) | 
Yes | 343/497 (69.0) | 1.42 (1.15–1.75) | 0.001b | 315/496 (63.5) | 1.44 (1.17–1.76) | <0.001b | 407/497 (81.9) | 0.98 (0.76–1.26) | 0.875 | 46/498 (9.2) | 2.05 (1.42–2.95) | <0.001b | 434/496 (87.5) | 1.35 (1.01–1.80) | 0.043b
Employed |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 
No | 471/800 (58.9) | 1.0 (ref) |  | 409/798 (51.3) | 1.0 (ref) |  | 667/799 (83.5) | 1.0 (ref) |  | 31/799 (3.9) | 1.0 (ref) |  | 680/795 (85.5) | 1.0 (ref) | 
Yes | 1154/1796 (64.3) | 1.26 (1.06–1.49) | <0.01b | 1052/1792 (58.7) | 1.35 (1.14–1.60) | <0.001b | 1460/1794 (81.4) | 0.87 (0.69–1.08) | 0.199 | 111/1797 (6.2) | 1.63 (1.09–2.45) | <0.05b | 1501/1787 (84.0) | 0.89 (0.70–1.12) | 0.319

According to the multivariable logistic regression model (Table 3), participants with a postgraduate qualification had higher odds of being aware of donation events (OR 1.38 [1.11–1.72], p = 0.003) and organ donation cards (OR 1.41 [1.14–1.74], p = 0.001), as well as carrying an organ donation card (OR 2.00 [1.37–2.92], p < 0.001) and supporting the inclusion of authorization in official documents (OR 1.40 [1.04–1.89], p = 0.026). Similarly, employed participants had higher odds of awareness regarding donation events (OR 1.37 [1.14–1.65], p < 0.001) and cards (OR 1.52 [1.27–1.83], p < 0.001), and were more likely to possess a donation card (OR 1.80 [1.17–2.76], p = 0.008). Compared with females, male participants had lower odds of being aware of donation events (OR 0.64 [0.54–0.76], p < 0.001) and donation cards (OR 0.57 [0.48–0.67], p < 0.001). Males also had lower odds of supporting ODAD (OR 0.76 [0.61–0.94], p = 0.012), carrying a donation card (OR 0.41 [0.28–0.61], p < 0.001), and supporting the inclusion of authorization in official documents (OR 0.76 [0.60–0.95], p = 0.016). Regarding nationality and region of residence, Saudi citizens had higher odds of awareness of organ donation cards (OR 1.76 [1.24–2.50], p = 0.002), whereas residing in Makkah Province was associated with lower odds of awareness of donation cards (OR 0.72 [0.62–0.85], p < 0.001).

Characteristic | Heard of organ donation event | Heard about organ donation card | Support organ donation after death | Carrying an organ donation card | Support adding organ donation authorisation to official documents
 | 95% CI |  |  | 95% CI |  |  | 95% CI |  |  | 95% CI |  |  | 95% CI | 
OR | Lower | Upper | p-value | OR | Lower | Upper | p-value | OR | Lower | Upper | p-value | OR | Lower | Upper | p-value | OR | Lower | Upper | p-value
Male gender | 0.64 | 0.54 | 0.76 | <0.001a | 0.57 | 0.48 | 0.67 | <0.001a | 0.76 | 0.61 | 0.94 | 0.012a | 0.41 | 0.28 | 0.61 | <0.001a | 0.76 | 0.60 | 0.95 | 0.016a
Saudi citizenship | 1.15 | 0.81 | 1.63 | 0.448 | 1.76 | 1.24 | 2.50 | 0.002a | 0.91 | 0.57 | 1.44 | 0.673 | 1.48 | 0.59 | 3.70 | 0.404 | 1.07 | 0.67 | 1.72 | 0.776
Residence of Makkah province | 0.87 | 0.74 | 1.03 | 0.104 | 0.72 | 0.62 | 0.85 | <0.001a | 0.88 | 0.71 | 1.08 | 0.209 | 0.71 | 0.50 | 1.01 | 0.055 | 1.05 | 0.84 | 1.31 | 0.682
Postgraduate qualification | 1.38 | 1.11 | 1.72 | 0.003a | 1.41 | 1.14 | 1.74 | 0.001a | 1.03 | 0.79 | 1.34 | 0.831 | 2.00 | 1.37 | 2.92 | <0.001a | 1.40 | 1.04 | 1.89 | 0.026a
Employed | 1.37 | 1.14 | 1.65 | <0.001a | 1.52 | 1.27 | 1.83 | <0.001a | 0.93 | 0.73 | 1.18 | 0.547 | 1.80 | 1.17 | 2.76 | 0.008a | 0.90 | 0.70 | 1.16 | 0.432

Among those who did not support ODAD, a range of concerns emerged, highlighting specific emotional, religious, and procedural factors that influenced their stance. As illustrated in Figure 1, religious concerns were the most frequently cited concerns (26%), followed by unspecified “other” reasons (22%) and personal feelings (20%). Gender-stratified analysis revealed that religious concerns were more common among male participants (33%), whereas females more frequently cited personal feelings (23%) and unspecified “other” reasons (26%). Religious concerns and personal feelings were the main causes reported for not supporting ODAD among all participants, with a slightly higher prevalence in males (20%) compared with females (15%). Lack of organizational clarity was the least cited barrier (14%) and there was minimal variation by gender.

Figure 1: Main reasons preventing non-supporting participants from supporting organ donation after death (n = 464).