The importance of Spanish-language similarity in friend selection.

Human organs undergo various changes, some reversible through the body's natural regulatory mechanisms, and others irreversible, potentially leading to organ failure. Organ donation (OD) is one of the greatest medical advancements, being a life-saving solution for patients suffering from irreversible organ failure. By definition, OD is the process of giving one's organs or tissues to someone in need of a transplant. Donations may occur either from a Living Donor (LD), who provides cells, tissues, or organs, or from a Deceased Donor (DD), declared dead according to established medical criteria, from whom organs are recovered for transplantation. Thus, one donor can potentially save up to eight lives and improve the quality of life of many others. Despite medical advancements, the demand for transplantable organs far exceeds supply, leading to a persistent global shortage. The World Health Organization estimates that only 10% of the worldwide demand is currently met. In 2023, a total of 172,397 organ transplants were performed worldwide. Consent systems play a major role in shaping donation rates. In explicit consent systems, used in countries such as the United States, Canada, Germany, Denmark, and Japan, individuals must actively register their willingness to donate, typically through a donor card or national database. In contrast, presumed consent systems, as adopted in Spain, France, Italy, Portugal, and Belgium, consider all citizens potential donors unless they have formally opted out. However, donation rates are influenced by multiple factors beyond consent legislation, including healthcare infrastructure, transplant coordination, public awareness, and cultural norms. In 2023, Spain reported the highest rate of DDs (49.38 per million population (PMP)), while Turkey had the highest rate of LDs (55.37 PMP). In Lebanon, OD is regulated by Law Number 109/1983, which requires family consent even if the deceased had previously expressed a willingness to donate. The National Organization for Organ and Tissue Donation and Transplantation in Lebanon (NOD-Lb), established in 1999 under the Ministry of Health, is the only official body authorized to oversee all organ, tissue, and cell donation and transplantation activities in the country. NOD-Lb ensures that donations follow strict medical criteria, are transparent, and are fair. However, Lebanon still records fewer than two donors PMP annually, among the lowest rates worldwide. According to NOD-LB, although 3200 individuals are registered as organ donors, around 700 patients remain on the transplant waiting list. Experts have estimated that the country's deceased donor rate could reach approximately 14 PMP under optimal conditions, potentially increasing the number of life-saving transplantations annually. However, public awareness and consent toward OD remain suboptimal, with studies highlighting the need for educational and policy initiatives to enhance willingness and family authorization for donation in Lebanon. Knowledge and attitudes have consistently been reported as factors associated with OD. In Saudi Arabia, organ donor registration has been associated with cultural and family influences, religious beliefs, body integrity concerns, and medical mistrust. In Tunisia, while OD is widely recognized as important, research has reported that low awareness, cultural barriers, and mistrust in the medical system are associated with lower registration rates. Lebanon faces similar challenges. A national cross-sectional study found that supportive attitudes were associated with greater knowledge, and that willingness to donate increased under hypothetical scenarios in which religion and law supported the practice. Demographic factors such as age, sex, place of residence, and income were also associated with attitudes. Understanding the Lebanese public's knowledge, attitudes, and willingness toward OD is therefore essential to address the national shortage and strengthen the donation program. Specifically, limited updated evidence is available regarding the specific barriers and facilitating conditions that may influence donation decisions among Lebanese adults. A better understanding of these factors could help inform targeted awareness campaigns and public health strategies to improve OD acceptance and registration. Therefore, this study aimed to assess knowledge, attitudes, and composite willingness toward OD (including current willingness and willingness under facilitating conditions) among Lebanese adults.