Overcoming barriers and enhancing strategies in organ transplantation systems: a systematic review

Background Organ transplantation is one of the major achievements of modern medicine, yet the global shortage of organs remains a serious challenge. This shortage increases mortality among patients on waiting lists. Although up to 80% of people support organ donation, far fewer register as donors, creating a clear “knowledge–action gap.” Aim This systematic review aimed to identify key barriers to organ donation and evaluate strategies to improve donation rates. Methods A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for peer-reviewed studies published in the last decade. Following PRISMA guidelines, 33 studies were included, covering randomized controlled trials, cross-sectional, and mixed-methods designs. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results Barriers to organ donation were found to be complex and interconnected, involving social, psychological, and systemic factors. Lack of knowledge was the most common issue, with up to 91% reporting poor awareness and only 11% aware of relevant laws. Sociocultural and religious concerns also influenced decisions, with 38.8% reporting misconceptions and 58% lacking family support. Psychological barriers were significant, with 69% fearing health complications and expressing mistrust in the healthcare system. At the system level, despite general willingness, only 37.3% of healthcare professionals had donor cards. However, targeted interventions showed positive outcomes. Educational programs increased willingness to register from 12% to 68% and improved knowledge from 36.4% to 88.5%. Conclusion The main barrier to organ donation is the gap between willingness and action, largely due to uncertainty and lack of understanding. Bridging this gap requires a combined approach: providing simple, culturally appropriate education about donation and improving healthcare systems to build trust and reduce financial and practical burdens on donors.