Non-probability, convenience sampling was used in this study. Participants were informed about the questionnaire and were given the proper knowledge about the purpose of the study. Data were collected using a validated questionnaire, comprising 11 items. These items evaluated their understanding of key concepts related to organ donation, including the term organ donation, the concept of brain death, the roles of an organ donor, the distinction between organs donated by living donors and deceased donors, the process of organ retrieval, the presence and function of the Organ Transplant Unit in the UAE, and specific procedures such as heart transplantation and kidney transplantation. Additionally, respondents were questioned about their awareness of the most commonly and least commonly donated organs and whether they or their family had received or donated organs.

For knowledge scores, participants were given scores of 1 and zero for correct and incorrect responses for each item. To assess the percentage of participants with poor knowledge scores, we consider participants whose scores were 50% or less to have poor knowledge while those whose scores were above 50% to have adequate scores.

In this study, more than two-thirds of the respondents (70.8%) demonstrated adequate knowledge of organ donation. This level of knowledge is notably higher than that reported in several studies across the region. For example, Alwahaibi et al. found that only 34.1% of 2,125 university students in Oman had good knowledge regarding organ donation. ¹⁶ Similarly, Mohamed et al. reported that among students at Minia University in Egypt, only 28% demonstrated good knowledge, while 40% had fair knowledge and 32% had poor overall knowledge. ¹⁷

Likewise, Majeed et al. observed even lower levels of good knowledge among nursing students in Iraq, with only 12% classified as having good knowledge, compared to 71% with fair and 17% with poor knowledge. ¹⁸ Our findings are consistent with a recent meta-analysis that reported a pooled knowledge level of 69% in Middle Eastern populations. ¹¹ Taken together, this suggests that university stakeholders in the UAE may possess relatively higher awareness compared to peers in neighbouring countries.

Regarding specific knowledge items, most respondents in our study accurately identified fundamental concepts related to organ donation, including the meaning of organ donation (82.0%), the definition of brain death (83.9%), the possibility of donating organs while alive (83.0%), and the feasibility of postmortem corneal harvesting (89.6%). Awareness of brain death in our sample was substantially higher than that reported by Vincent et al., in which only 46.9% and 42.1% of respondents recognized brain death and corneal donation, respectively. ⁷ Similarly, Asmita et al. found that only 61.7% of participants understood that organs can be donated either before or after death. ⁹ These comparisons underscore relatively strong foundational knowledge among studied populations

Despite these strengths, substantial knowledge gaps were noted in areas related to organ donation legislation and regulatory oversight in the UAE. Only 68% of participants knew which government entity oversees transplantation, and just 55.8% were aware of the existence of an official national organ donation registry. These findings align with earlier studies showing persistently low awareness of organ donation laws in the UAE, including a national study reporting that fewer than 40% of participants were familiar with transplantation legislation, ¹⁴ and another by Seddiq et al., where only 55% demonstrated awareness of legal frameworks. ¹⁵ Low awareness of legal provisions is not unique to the UAE; a cross-sectional study among 2,743 Egyptians showed that only 36.9% were aware of four to six key legal articles governing organ donation, ¹⁹ and a Saudi Arabian study reported awareness as low as 11.3%. ²⁰ Collectively, these findings highlight a widespread knowledge deficit regarding regulatory structures across the Eastern Mediterranean region.

The most pronounced gaps in our study involved understanding donor eligibility criteria and the timeframes required for organ viability, with 57.8% and 67.1% of participants, respectively, demonstrating inadequate knowledge. Comparable gaps were reported by Alessa et al., who found that 53.46% of social media users lacked knowledge of organ donation requirements. ²¹ Misconceptions regarding the religious permissibility of organ donation were also prevalent, reported by 41.4% of respondents. Similar misconceptions have been documented in Turkey (22%), ²² Saudi Arabia (39.29%), ²³ and Jordan (66%). ²⁴ These findings emphasize the need for targeted educational interventions that address not only biomedical and legal aspects, but also common cultural and religious misunderstandings surrounding organ donation.

In this study, no significant differences in knowledge levels were observed across sociodemographic variables such as age, gender, nationality, or religion. Existing literature shows mixed evidence in this regard. Our findings align with those of El-Sherief et al., who reported no significant gender differences in knowledge scores among students at Minia University in Egypt. ²⁵ In contrast, Alwahaibi et al. found that female students in Oman demonstrated higher levels of good knowledge compared with males (36.8% vs. 28.5%, p < 0.001), although age was not associated with knowledge in their sample. ¹⁶ Somaili et al. reported yet another pattern, noting significant differences across age and marital status groups, but no differences by gender or educational level. ²³ Similarly, a study among healthcare professionals found no variation in knowledge across religious groups, which is consistent with our findings, but reported significant differences across age, gender, and occupation. ²⁶ Together, these divergent findings underscore the complex and context-dependent nature of sociodemographic influences on organ donation literacy.

Our study identified university and college affiliation as important determinants of knowledge. Participants affiliated with medical colleges or universities offering medical programs demonstrated significantly higher knowledge scores. These findings mirror those of Almutairi, who observed higher knowledge levels among medical and physiotherapy students in Saudi Arabia (p < 0.001). ²⁷ Likewise, both El-Sherief et al. ²⁵ and Alwahaibi et al. ¹⁶ reported superior knowledge among medical compared to non-medical students. Furthermore, we found that faculty had markedly higher rates of adequate knowledge than both staff and students (84.4% vs. 68.3%), with faculty exhibiting a 2.668-fold increased likelihood of adequate knowledge compared with students (CI: 1.095–6.502, p = 0.031). This pattern is consistent with findings from Krishna et al., who reported significantly higher knowledge among faculty and residents compared to students and interns in medical colleges in Eastern India (73.9% vs. 41.5%). ²⁸ Collectively, these observations highlight potential shortcomings in current university curricula, suggesting that organ donation education may not be sufficiently embedded across academic programs. Strengthening curricular emphasis on organ donation could help boost the knowledge of young adults, who represent a critical demographic for sustaining national organ donation initiatives.

Unexpectedly, our study revealed a lower rate of adequate knowledge about organ donation among participants with a personal or family history of receiving or donating organs. Specifically, individuals with such a donor history had a 74.2% lower likelihood of demonstrating adequate knowledge compared with those without this background. This counterintuitive finding may reflect insufficient education or counseling provided to donors, recipients, and their families during the donation or transplantation process. Targeted educational efforts for these groups may therefore be essential to strengthen public understanding and support for organ donation programs. Our results contrast with those of Gupta et al., who reported that students with a family history of organ donation had more than twice the odds of possessing good knowledge [OR 2.25 (CI: 1.90–2.75), p < 0.01]. ²⁹

A strong association was also observed between knowledge and attitudes toward organ donation. Participants with positive attitudes were significantly more likely to have adequate knowledge. This relationship is supported by Alwesmi et al., who found that nursing students willing to donate their organs had higher knowledge levels. ³⁰ Fan et al. similarly reported that both higher knowledge and more favorable attitudes were independently associated with greater willingness to donate among the general public in China. ⁸ Evidence from these studies suggests a bidirectional relationship between knowledge and attitudes, with improvements in one likely reinforcing gains in the other. This underscores the importance of comprehensive educational strategies that address both cognitive and affective components of organ donation literacy

This is one of the few studies in the UAE to assess organ donation knowledge across multiple groups within universities, including students, faculty, and staff. The inclusion of three major universities enhances the diversity and representativeness of the sample within the Ajman Emirate. We tried to improve the reliability of the study by using a validated questionnaire with a structured scoring system; also, the application of multivariable logistic regression allowed for the identification of independent predictors of knowledge after controlling for possible confounding effects of other variables. The study has some limitations, like the use of convenience sampling, which limits generalizability to all university populations in the UAE. Also, the self-administered questionnaire approach that we had used may be prone to self-selection of some participants who were more interested and perhaps more aware of organ donation.

To improve organ donation literacy, organize regular educational campaigns, workshops, and seminars with medical professionals and transplant organizations. Integrate organ donation topics into academic curricula and use digital platforms to spread awareness. Collaborate with health authorities for donor registration drives and invite donors and recipients to share their experiences. Establish peer education programs to encourage grassroots engagement.