Understanding urban–rural differences in organ donation attitudes in Punjab: A cross-sectional study on knowledge, barriers, and behavioral predictors

Background: India faces a critical shortfall in organ donation, with rural–urban disparities compounding the problem. This study aimed to assess and compare the knowledge, attitudes, and perceived barriers to organ donation between urban and rural populations in Punjab and to identify predictors of willingness to donate. Methodology: A cross-sectional, interviewer-administered survey was conducted among 455 adults attending outpatient services at Urban Health Training Centre and Rural Health Training Centre. Participants were selected through systematic sampling. A prevalidated bilingual questionnaire assessed knowledge, attitudes, willingness, and perceived barriers regarding organ donation. Results: The overall awareness was high in both groups (Urban: 87.07%; Rural: 80.27%), and urban respondents had significantly better factual knowledge, especially regarding live versus deceased donation ( P < 0.001). Rural respondents, however, demonstrated greater comfort in discussing donation ( P < 0.001) and had more family support ( P < 0.001). Willingness to donate organs was similar across groups (~43%). Knowledge was a strong and consistent predictor of willingness to donate organs (odds ratio ≈ 3.8 in both groups), whereas discussing organ donation was not significant. Perceived barriers such as organ misuse and procedural complexity were more prevalent in rural participants. Conclusion: Targeted educational interventions that address knowledge gaps and system-related fears, especially in rural areas, are critical to improving donation rates. Improving public trust and simplifying messaging may help translate awareness into actual donor registration.