背景 器官移植已经广泛应用于临床，但供体器官短缺的状况严重制约着器官移植技术的应用，同时衍生出一系列社会问题。在此背景下，本研究调查中国公众器官捐献认知、态度、意愿的现状及相关关系，探讨分析影响中国公众器官捐献意愿的关键因素，提出切实可行的提升公众捐献意愿的建议与思路。方法 本次研究采用问卷调查法对涵盖中国东中西部以及东北地区的912名公众进行认知、态度及意愿调查。采用t检验、方差分析对不同特征人群捐献认知、态度及意愿进行差异分析，采用卡方检验对2019年和2024年公众器官捐献意愿进行对比分析，利用Pearson相关分析认知、态度与意愿之间的相关性，采用多元线性回归分析意愿的关键影响因素。结果 本研究共发放问卷1000份，有效问卷率为91.2%。具体结果如下：（1）中国公众整体认知水平偏低。公众对器官移植与捐献的知晓率较高，但对器官捐献相关制度、法律法规、捐献程序以及脑死亡概念等知识缺乏深入了解。（2）中国公众整体器官捐献态度较为积极。公众普遍认同器官捐献所带来的个人价值及社会价值，但同时对器官捐献所涉及的法律法规、传统观念以及家庭压力等因素存在不同程度的担忧和顾虑。（3）中国公众实际器官捐献意愿率为48.25%，“情境化”预期意愿率为79.82%；器官捐献志愿登记意愿率为50.55%，而实际志愿登记率仅为11.18%，公众捐献意愿转化为实际行动中具有显著落差。（4）中国公众器官捐献认知、捐献态度以及人口特征中的性别、年龄、文化程度、无偿献血经历、器官移植经历是影响器官捐献意愿的重要因素（P＜0.05）。（5）相较于2019年，公众在2024年的认知水平显著降低，态度倾向性具有显著差异，捐献意愿强度自评分数显著降低，志愿登记率及登记意愿率无显著差异。（6）器官捐献与移植知识、经验以及对生命和死亡的长久思考是促使个体进行器官捐献志愿登记并最终付诸实际行动的主要动机。结论 公众器官捐献意愿是认知、观念、制度以及社会支持系统等多种因素相互作用的结果。缓解器官供体短缺，需要从法律法规、制度建设、宣传教育等多方面入手，制定相应对策，有效提升公民器官捐献意愿和实际器官捐献率。
Background Organ transplantation has been widely used in clinical practice, but the shortage of donor organs severely constrains the application of organ transplantation technology, leading to a series of social issues. In this context, the current study investigates the current status and related relationships of the Chinese public’s awareness, attitudes, and willingness toward organ donation, analyzes the key factors influencing the willingness of the Chinese public to donate organs, and proposes practical suggestions and strategies to enhance public donation willingness.Methods This study employed a questionnaire to investigate the awareness, attitudes, and willingness of 912 respondents covering eastern, central, western, and northeastern regions of China. T-tests and ANOVA were used to analyze the differences in donation awareness, attitudes and willingness among different demographic groups. Chi-square tests were used to compare and contrast the public’s organ donation willingness between 2019 and 2024. Pearson correlation analysis was used to examine the relationships between awareness, attitudes, and willingness, while multiple linear regression analysis was used to identify factors influencing willingness.Results This study distributed a total of 1000 questionnaires, with an effective response rate of 91.2%. The specific results are as follows:(1) The overall level of public awareness in China is relatively low. The public has a high awareness of organ transplantation and donation but lacks an in-depth understanding of related systems, laws and regulations, donation procedures, and concepts such as brain death.(2) The overall attitude of the Chinese public towards organ donation is relatively positive. The public generally acknowledges the personal and societal values brought by organ donation. However, concerns and worries of varying degrees exist among the public regarding factors such as laws, regulations, traditional beliefs, and family pressures related to organ donation.(3) The actual willingness rate of the Chinese public for organ donation is 48.25%, with the "situational" expected willingness rate being 79.82%. The willingness rate for organ donation volunteer registration is 50.55%, yet the actual registration rate stands at only 11.18%, indicating a significant gap between public donation willingness and actual actions.(4) Factors influencing organ donation willingness among the Chinese public include donation awareness, attitudes, and demographic characteristics such as gender, age, educational level, experience of unpaid blood donation, and experience of organ transplantation (P<0.05).(5) In comparison to 2019, the public’s awareness level in 2024 has significantly decreased, attitudes exhibit significant differences, and the self-rated intensity of donation willingness has significantly decreased, while volunteer registration rates and registration willingness rates show no significant differences.(6) The knowledge and experience of organ donation and transplantation, as well as long-term contemplation on life and death, are the primary motivations that drive individuals to register their willingness for organ donation and eventually take practical actions.Conclusion Public willingness for organ donation results from the interaction of various factors such as awareness, traditional beliefs, laws and regulations, and social support system. To alleviate the problem of organ donor shortages, interventions are needed from multiple perspectives including laws and regulations, institutional construction, and education. Developing corresponding strategies to improve public awareness and willingness for organ donation is crucial to increase the actual organ donation rate in China and save more patients’ lives.
