Abstract
IMPORTANCE: Organ transplant demand in the US far exceeds supply. Living donor organ transplantation (LDOT) offers a critical solution to reducing this shortage, yet its adoption remains limited. Understanding factors that influence willingness to donate is essential for expanding the living donor pool. OBJECTIVE: To examine whether knowledge of LDOT, perceptions of fairness in the transplant system, geography, socioeconomic status, and religiosity are associated with individuals' willingness to become living organ donors. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed responses from the 2019 National Survey of Organ Donation Attitudes and Practices (NSODAP). Participants were aged 18 years or older. Poststratification weights were applied to align the sample with US census demographic characteristics. Data were analyzed from November 2024 through May 2025. EXPOSURES: Socioeconomic status, region of residence, knowledge of living donation, perceptions of inequality in transplantation, and religiosity. MAIN OUTCOME AND MEASURES: The primary outcome was the self-reported likelihood of donating an organ to a family member while living. Composite scores were created to assess knowledge about living donation, perceptions of fairness in organ transplantation, and religiosity. Multivariable logistic regression was performed to evaluate associations with willingness to donate, adjusting for demographic and socioeconomic factors. RESULTS: Of the 9922 survey respondents, 5264 (53.2%) were women, and 7801 (78.9%) reported an educational level of postsecondary training or above. The largest proportion of participants was aged 18 to 34 years (3006 [32.6%]), followed by 50 to 64 years (2390 [25.9%]), and most had health insurance (8547 [86.1%]); 8667 (87.4%) reported being likely to donate. Women were more likely to report willingness to donate than men (odds ratio [OR], 1.49; 95% CI, 1.23-1.81; P < .001), and Asian participants were less likely to report willingness to donate than White participants (OR, 0.72; 95% CI, 0.55-0.94; P = .02). Higher knowledge scores were associated with increased willingness to donate (OR, 1.62; 95% CI, 1.49-1.77; P < .001), while lower perceptions of fairness in organ allocation were associated with decreased willingness (OR, 0.85; 95% CI, 0.78-0.92; P < .001). CONCLUSIONS AND RELEVANCE: In this cross-sectional study analyzing survey data from NSODAP, willingness to become a living organ donor was associated with knowledge, perceptions of fairness within the organ transplant system, and socioeconomic factors. The findings suggest that targeted education and transparency in organ allocation policies may help expand the US living donor pool.