Analysis of Personal and Cultural Beliefs Related to Organ Donation in Saudi Arabia

Academic Journal of Research and Scientific Publishing | Vol 5 | Issue 57
Publication Date: 05-01-2024
www.ajrsp.com 67
ISSN: 2706-6495

              Analysis of Personal and Cultural Beliefs Related to Organ Donation in Saudi Arabia

Yaser M. Kattoah*1. Corresponding author: ykattoah@gmail.com

Abstract
This article aimed to perceive and analyze the obstacles and demanding situations dealing with
the organ donation manner in Saudi Arabia, and to observe how cultural factors affect society’s
outlook and choices concerning organ donation, as organ donation contributes significantly to
improving public health and saving the lives of people who be afflicted by Incurable sicknesses.
Through using the experimental approach and the usage of the questionnaire as an examination
tool among the residents of KSA during 2023, this cross-sectional study showed that lack of
awareness and information are principle obstacles to organ donation in KSA. This is due to
personal and cultural beliefs connected to habits and traditions, and we found that the doctor is
responsible for the case of brain death and the organ transplant coordinator must be fully aware of
these matters, as well as they must have a spirit of inquiry and good listening, and they must also
have a sense of the non-verbal language of the brain-dead’s family that may be a major reason for
their approval to donate the organs of the brain dead, and taking into consideration that organ
donation awareness as one of the critical issues in transplantation centers.
Keywords: Organ donation, Challenges, Cultural influences, Personal influences.


1. Introduction
Organ donation is a multifaceted and delicate subject that intertwines personal convictions and
cultural viewpoints. A multitude of factors, encompassing religious, ethical, and cultural
considerations, can shape people’s stance on organ donation (Sharp & Tollefsen, 2019, pp. 1-13),
(Goyal, 2012, pp. 282-285). Religious beliefs on organ donation diverge widely. Some religions advocate it as an altruistic act of benevolence, while others might express reservations or impose restrictions. Therefore, seeking advice from religious leaders or scholars is crucial. When looking at ethical apprehensions about organ donation, such as concerns about the determination of death, consent, or the possibility of exploitation, they may be present in some individuals. These concerns necessitate transparent communication and education (Choudhury et al., 2020).
Some people highly regard personal autonomy and the right to make decisions about their bodies.
Others might stress the necessity of obtaining informed consent prior to any organ donation
procedures (Dalal, 2015, pp. 44-51).
Cultural beliefs about death and life after death can shape views on organ donation. In certain
cultures, the body is deemed sacred and should remain undisturbed after death, while others might
perceive organ donation as a means to continue contributing and assisting others posthumously
(Li MT et al., 2019, pp. 1001-1018). The attitudes of a person’s community or cultural group can significantly influence their views. The social norms and expectations within a specific community can mold an individual’s perspective on organ donation. Cultural customs and practices related to death and burial can affect the readiness to donate organs. It is vital to understand and respect these traditions when discussing organ donation within particular cultural contexts (Cotrau et al., 2019, pp. 12-14).
Enhancing awareness about organ donation, debunking myths and misconceptions, and providing
accurate information can assist individuals in making informed decisions (pennmedicine.org,
2019).
Acknowledging and respecting the diversity of beliefs is crucial. Health care professionals should
approach discussions about organ donation with sensitivity and cultural competence (Attum et al.,
2023).
Promoting community engag ement in discussi ons about organ donation, involving cultural
leaders, and encouraging open dialogue can lead to a broader understanding and acceptance (Timar
J et al., 2021, pp. 380-394).
Organ donation often involves individuals who are declared brain dead. Brain death is defined as
the total and irreversible loss of all brain function, including the capacity for the brainstem to
regulate respiratory and vegetative activities (Roopan, 2023).
The diagnosis of brain death is made by one or more physicians not associated with a
transplantation team (donorrecovery.org, learn-understanding-brain-death) The process of
confirming brain death involves a series of tests to determine whether any brain activity is present.
These tests are carried out twice to minimize any chance of error. The tests used to determine brain
death include checking for reactions to light, physical stimulation, and certain reflexes. The person
is also disconnected from the ventilator for a short period of time to see if they make any attempt
to breathe on their own. Brain death is diagnosed if a person fails to respond to all of these tests
(nhs.uk, conditions-brain-death-diagnosis).
In the context of organ donation, brain death is the circumstance under which the donation of vital
organs most commonly takes place. Once brain death is declared, it means the person has died, but
other organs, such as the heart, kidneys, or liver, can still work for a short time if the breathing
machine is left in place. This allows for the possibility of organ donation. However, the concept
of brain death and organ donation is often misunderstood and can be particularly difficult to broach
with different communities due to cultural and religious beliefs. In many societies, there are
cultural expectations of family involvement in medical care, and an inability to declare brain death
without consent from the family can complicate the process (Terunuma, 2021)
Cultural customs and practices related to death and burial can affect the readiness to donate
organs. It is vital to understand and respect these traditions when discussing organ donation within
particular cultural contexts. Therefore, health care professionals should approach discussions
about organ donation with sensitivity and cultural competence. Promoting community engagement
in discussions about organ donation, involving cultural leaders, and encouraging open dialogue
can lead to a broader understanding and acceptance. It’s also important to enhance awareness about
organ donation, debunk myths and misconceptions, and provide accurate information to assist
individuals in making informed decisions (AMA J Ethics, 2020).
In Saudi Arabia, organ donatio n is influenced by a variety of factors, including personal beliefs,
cultural norms, and religious teachings. Despite concerted efforts to increase organ donation, the
gap between the need for organs for transplantation and the lack of donors has been increasing
globally (Alobaidi, 2023).
In fact, when we talk about brain death, we must remember the meaning of illness and death, and
therefore we must keep in mind that there are some matters that must be clarified to the family of
the brain-dead person and prepare them to make the decision to donate or not, as follows: the
extent of the family’s knowledge of the nature and meaning of brain death, and the mechanism for
implementing regulatory procedures to confirm Brain death, the presence of a person responsible
for a brain-dead patient is important during the routine procedures to confirm brain death and to
communicate with the medical team and make important decisions, knowing the personal or
cultural beliefs held by the family regarding organ and tissue donation, whether the decision to
donate will be made individually or will the decisions be made as a family. Therefore, through this
study, we will focus on the culture of organ donation in the Kingdom of Saudi Arabia, based on
the variables of age, level of education, location, and attitudes toward organ donation as dependent
variables.

2. Previous work
Organ donation in Saudi Arabia is influenced by both personal beliefs and cultural factors. A study
conducted in the SA found that only 19.6% of participants were willing to register as organ donors.
However, 44.3% of the participants agreed that they were healthy enough to donate organs.
Positive associations were found between intention for organ donation and beliefs that organ
donation is a good thing, can save someone's life, and can have a positive impact on life after
death. The study also highlighted the importance of promoting awareness about organ donation,
particularly in terms of religious permissibility, to increase donation rates (Alobaidi, 2023).
Doerry et al. explored the religious and cultural aspects of organ donation in order to reduce the
gap through understanding different religious beliefs. They found that the religious beliefs of
patients, potential donors, and healthcare professionals play an important role in the decisionmaking
process (Doerry et al., 2022).
In China, a study examined the influence of traditional Chinese culture on organ donation within
the frameworks of Confucianism, Buddhism, and Taoism. Within each of these cultural systems,
certain expressions or statements in modern Chinese society are often perceived as conflicting with
organ donation, especially cad averic organ donat ion. It's not that the fundamental tenets of these
systems inherently oppose cadaveric donation, but rather, contemporary Chinese individuals have
not developed and established relevant ritual practices that align with the central concerns of organ
transplantation. The article concludes that to encourage more donations, there is a necessity to
establish pertinent ritual practices that support organ donation in accordance with the central
concerns of these cultural systems (Yu Cai, 2013).
Brisnahan et al. show that spiritual connection with the transplant recipient, spiritual concern about
removing organs, and attitudes toward organ donation significantly predicted willingness to
become an organ donor for participants in USA and China (Bresnahan et al., 2010, pp. 133-146).
In some cases, participants thought organ donation was a noble deed. They believe that importance
of context, values and beliefs, lack of knowledge about donation influence of spiritual or cultural
values, lack of communication, and the need to preserve an intact body in relation to death and
dying (Molzahn et al., 2005, pp. 82-98).
In South Korea, traditional Confucian-based thought still prevails. Barriers to organ donation in
South Korea, include Confucianism, misunderstandings and myths, organs as spare for selling,
lack of clarity in the definition of death in the new legislation, and limited medical insurance
coverage (Kim et al., 2004, pp. 147-154).
Similarly, Asian Americans hold more negative attitudes toward and participate less frequently in
a large, urban organ-donation program (Alden and Cheung, 2000, pp. 293-314). In UK, culture
and religion play a much less prohibitive part in determining the level of organ donation
(Randhawa, 1998, pp. 1949-1954). While, in Asian countries, Living-related kidney donation is
more social than cultural (Woo, 1992, pp. 421-427).
In relation to the topics addressed in prior research, there appears to be a gap in studies examining
the proper execution of standard procedures for confirming brain death, which is vital for an
accurate diagnosis. In addition, there is a need to investigate the role of the individual responsible
for the patient declared brain-dead during these procedures due to its significance in liaising with
the medical team and making crucial decisions. It’s also necessary to determine if the norms or
procedures reflecting the culture of handling brain-dead patients involve respect for the patient’s
dignity, open communication with the family, and adherence to ethical guidelines during the
process of confirming brain death and discussing potential organ donation.
The results can highlight the differences betwee n regional cultures in the Kingdom due to the
existence of multiple cultures across the regions, and their influence on organ donation,
considering the beliefs, traditions, and practices associated with these subjects.

3. Methodology
3.1. Study Design and Participants
An online survey was conducted among the residents of KSA during 2023 using a questionnaire
created in Google Forms. This cross-sectional study was designed by a panel of experts who
suggested appropriate questions to explore the correlation between organ donation & personal and
cultural beliefs in Saudi Arabia. The aim of the study was clearly stated at the beginning of the
questionnaire, and participants were only allowed to proceed with the survey after they explicitly
agreed to participate.
3.2. Instruments
The survey was divided into three sections. The initial section collected socio-demographic
information such as the participants’ age, education level, and location. The second section aimed
to gauge the participants’ general knowledge about organ donation. The final section delved into
the participants’ normative, behavioural, and control beliefs about organ donation by assessing
their agreement with various statements.
3.3. Statistical Analysis
The Microsoft Excel was used to analyze the data. Descriptive statistics were utilized to analyze
the variables of the study.

4. Results
The Statistics of the variables are calculated based on respondent answers as displayed and
summarized in table 1.Table 1. Statistics of the variables based on respondent answers.
Variable %
Age 18-30 year
31-50 year
51-65 year
66 and more
32.2
55.8
10.9
1.1

Location Eastern P rovince
Western Region
Central Region
Northern Region
Southern Region
Outside the Kingdom
9.9
37.5
32.4
5.2
8.8
6.2

Education high school
diploma
high diploma
university degree
master degree
PhD degree
34.6
6.8
5.9
44.6
5.7
2.4

Do you agree on Organ donation No
Yes
61.5
38.5

If the answer is yes, have you
informed your parents of this desire?
No
Yes
76.2
23.8

If the answer is no, state the reason Fear of them not agreeing
Other reasons
21.8
78.2

Have you ever seen an awareness
advertisement about organ failure and
organ donation?
No
Yes
55.9
44.1

Do you have enough information
about organ failure and organ
donation?
No
Yes
54.3
45.7

If the answer is no, state the reason Weak visual media awareness.
Negligence of the press and journalists and
media, Saudi Center for Organ
Transplantation is negligent in this aspect,
and Organ transplantation centers have a
weak role in educating patients.
All of the above.
26.4
10.1
63.5

Do you agree that some ha bits and
traditions may resist organ donation?
No
Yes
27.7
72.3

Do you believe the stories you hear
about organ donation?
No
Yes
52.3
47.7

If you were the decision maker to
agree to donate the organs of a braindead
person close to you, what would
be your decision?
I agree to donate his organs for the sake of
charity, kindness, and mercy.
I do not agree due to family circumstances.
I agree to donate his organs because obeying
God is from obeying the ruler (based on the
wise government’s approval of organ
donation).
58.5
39.5
2

If you were the decision maker to
donate the organs of a brain-dead
person, would you agree to transplant
a kidney taken from a brain-dead
person to a person close to him?
No
Yes
30.9
69.1

Do you have information about the
types of organ donation approved by
the Kingdom of Saudi Arabia?
No
Yes
62.2
37.8

If you have information about brain
death, will you talk to your family
educate them about this topic?
No
Yes
18.3
81.7

The majority of the study participants (61.5%) disagree to organ donation, and (76.2%) don’t even
attempt to discuss organ donation with their parents due to fear of them not agreeing (21.8%) and
other reasons (78.2%). Most of participant (55.9%) have not seen an awareness advertisement or
even have enough information (54.3%) about organ failure and organ donation, in addition to lack
of awareness and information about types of organ donation approved by KSA (62.2%). Most of
participants (72.3%) find that traditions may resist organ donation, although (52.3%) don’t believe
the stories they hear about organ donation.
There are (58.5%) who agree with organ donation of other people for the sake of charity, kindness,
and mercy. Also (69.1%) agree to transplant a kidney taken from a brain-dead person to a person
close to him. At the end (81.7% ) agree on convey more information about organ donation to their
family.

5. Discussion
The current research assessed the willingness to donate organs among the Saudi Arabian
population, taking into account personal and cultural beliefs. It was discovered that these beliefs
play a significant role in the decision-making process regarding organ donation in Saudi Arabia.
A similar conclusion was drawn from a recent study conducted in Qatar. The study, which
surveyed 1044 adults in a household setting, investigated their beliefs and intentions towards organ
donation (El-Menyar et al., 2020, pp. 122-127). Another study that examined the intentions towards organ donation among Americans and Koreans underscored the substantial impact of personal and cultural beliefs on the decision-making process for organ donation. (Yun and Park, 2010, pp. 130-137)
The current study also found that most of the participants (55.8%) are within 31-50 years old.
Around (44.6%) are university graduates, and (37.5%) live in Al-Gharbeia. Most of them (61.5)
refuse to donate organs for reasons not related to parental disapproval. Most of them (55.9%) are
even not interested in watching awareness advertisements about organ failure and organ donation,
and consequently (54.3%) have no sufficient information about this. A total of (63.5%) of them
attributed this to several reasons such as the lack of visual media awareness, negligence of the
press, shortcomings of the Saudi Center for Organ Transplantation, and the weak role of organ
transplantation centers in patient awareness. Significant portion (72.3%) believed that certain
customs and traditions pose barriers to organ donation. And nearly (52.3%) don’t believe the
stories told about organ donation. It turns out that (62.2%) do not have information about the types
of organ donation approved by the Kingdom. So components under personal and cultural beliefs
showed a statistically significant positive correlation with a definite intention for organ donation
which is consistent with previous study results. The comprehensive findings suggest that the intention to donate organs among the Saudi population is significantly shaped by personal and cultural (Ajzen, 1991), (Yun and Park, 2010) (Alobaidi, 2023). Worldwide, the establishment of policies for organ procurement for transplantation and systems promoting organ donation are rooted in the principle of selfless giving (Hafeeq et al., 2021, pp. 268-270), Organ donation represents the epitome of selfless behavior, where individuals driven by altruism establish a standard of volunteering fo r organ donation, thereby fostering a sense of
communal unity (Dopelt et al., 2022), In our study, there are (58.5%) believed that they might
support donating the organs of their brain-dead relatives as a form of charity, mercy, and
benevolence. For example, (69.1%) confirmed that they find no objection to transplanting a kidney
taken from a brain-dead person to their relatives. This induces statistically significant positive
correlation between altruistic beliefs and definite intention for organ donation. A recent study from
Qatar echoed these findings, with 95% of participants expressing agreement with the altruistic
principles underlying organ donation (Yun and park, 2010, pp. 130-137).
The findings of this study suggest that the Saudi population generally exhibits altruism in relation
to organ donation. Policies that create opportunities for individuals to express this altruism, such
as registering for organ donation, could foster a sense of social unity. However, one of the
significant challenges faced by organ donation initiatives in Middle Eastern countries is the
stagnant growth rate of deceased organ donations compared to voluntary ones (Shaheen, 2016, pp.
1387-1389).
In light of the existing research and the results of this study, it’s advisable to establish avenues that
support organ donors and their families, as this could enhance organ donation. Recently, King
Salman recognized the altruistic act of 200 Saudi citizens who registered in a government organ
donation program by bestowing upon them the King Abdulaziz Medal of Third Class (Arab News).
In addition, the Tawakkalna utility, in collaboration with the Saudi Center for Organ
Transplantation (SCOT), has also venerated organ donors with 3 classes of medals—gold, silver,
and bronze. This gesture of appreciation acknowledges their selfless contributions to patients
combating organ failure. (Saudi Gazette, Tawakkalna Awards Medals to Organ Donors) .The
government of KSA has verified its popularity of the significance of imparting help to donors via
these recent improvements.
Since organ donation regularly involves folks that are declared mind useless, in this case, I
observed that the health practitioner is liable for the case of brain demise and the organ transplant
coordinator have to be fully aware about these topics, as well as they must have a spirit of inquiry
and correct listening, and that they should even have a sense of the non-verbal language of the
brain-lifeless’s circle of relatives that may be a primary purpose for their approval to donate the
organs of the brain dead.


6. Conclusion
The research examined the relationship between personal and Cultural beliefs in Saudi Arabia
toward organ donation. The control variables consisted of age, level of education, and location.
Certainly, Weak role of media in spreading awareness. Furthermore, we have to keep in mind
organ donation awareness as one of the critical problems in transplantation centers, In addition to
that, the Continuation of Saudi Arabia's consciousness of organ donation Culture besides the
activation of advantageous non secular and social impacts could improve organ donation
nationwide. The dependent variables consisted of attitudes toward organ donation. Also, Most of
the research participants were willing to Willingness to be Living Organ Donors. And they wanted
to Support Organ Donation.

7. Recommendations:
1. Encouraging interest in organ donation organ donation within the Kingdom of Saudi Arabia,
in particular amongst people aged 31-50, and among university students.

2. Spreading visual media awareness about organ donation and types of organ donation approved
in the Kingdom of Saudi Arabia.

3. Holding courses for members of organ donation centers to educate patients.

4. Encouraging collaboration with social regulatory bodies to clarify problems related to organ
donation, emphasizing humanistic, altruistic, and moral values.

5. Strengthening public self-belief within the healthcare device and organ transplant centers,
fostering verbal exchange between medical groups and donor families in each instances.

6. Continuously encouraging donors and their households via moral standards, highlighting their
contributions with pride, and reflecting the values of altruism and team spirit in society.

7. Crafting powerful and clear regulations that help and encourage organ donation, incorporating
cultural and non-secular concerns.

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Copyright © 2024 Yaser M. Kattoah, Mashael Ali Alyamani, Rehaf Ali Alahmadi, Reem
Hussain Anajriah, Hajar Ghali Almohammadi, Hailah Ibrahim Hakami, Afaf Abdulhamid
Alturkistani, Mohammed Hatem M Kattouah, Weed Ahmed Al Zahrani, Aesha Mohammed Al
Shareef, Faizah Al Obaid Al anazi, Munayfah Muharrab Alruwaili, Seham Yahya Kaabi, Salha
Yahya Kaabi, Fatimah Abdulhadi Alanazi, AJRSP. This is an Open-Access Article Distributed
under the Terms of the Creative Commons Attribution License (CC BY NC)
Doi: https://doi.org/10.52132/Ajrsp.e.2024.57.4