Barriers and facilitators towards deceased organ donation in Arab and non-Arab Muslims
- Asmaa Al-Abdulghani(Author),
- Erica Cook(Supervisor),
- Gurch Randhawa(Supervisor)
Student Thesis:
Student thesis
Doctoral thesis
About the thesis
Background: The demand and supply gap for organ donation is a global phenomenon. However, evidence suggests that individuals from an Islamic background are less likely to donate organs after death. This is contributed to by various reasons, such as religious and cultural barriers, trust in the healthcare system, and a clash with understanding the concepts, such as brain death, when interfered with religious and cultural understanding of death. However, within the Muslim population living in Qatar, there are differences between the nationalities in their willingness to register and consent to deceased organ donation. Although existing studies in Qatar provide baseline data on knowledge, attitudes, and willingness regarding organ donation, they largely focus on descriptive differences by religion or nationality and do not explore the underlying factors shaping these differences from a subjectivist perspective, particularly among individuals of the same religion but different nationalities. Given Qatar’s predominantly expatriate population, this represents a critical gap that must be addressed to inform more inclusive and equitable organ donation policies. Building on this gap, this PhD study was undertaken in Qatar to explore the barriers and facilitators among Arab and Non-Arab Muslim populations. The aim of the PhD was addressed by three objectives namely: 1) To collect, synthesise and review the literature relating to the barriers and facilitators toward deceased organ donation among Muslims living globally, comparing similarities and differences between different Muslim communities, 2) To identify the barriers and facilitators toward deceased organ donation among Arab Muslims and non-Arab Muslims living in Qatar and the UK and 3) to identify the barriers and facilitators toward deceased organ donation based on the stakeholders' views in Qatar. Methods: Guided by a social constructivist philosophical paradigm and the socio-ecological model, this PhD comprised three objectives informed by the literature review. The first objective was addressed through a systematic review, analysed using narrative synthesis, enabling the integration of findings from both qualitative and quantitative studies. Findings from the review informed the development of the focus group discussion guide and the semi-structured interview guides for Objectives 2 and 3.
The second objective explored similarities and differences in perspectives on organ donation among Muslim individuals living in Qatar and the UK, situated within distinct social contexts. Participant nationalities were limited to Qataris and Egyptians (Arab Muslims) and Pakistanis and Bangladeshis (non-Arab Muslims), as these groups represented the two largest Arab and non-Arab Muslim populations in Qatar. The third objective involved semi-structured interviews with key stakeholders working within the Qatari organ donation system. Stakeholders involved in organ retrieval were excluded. Participants included public educators involved in national organ donation campaigns, transplant coordinators, religious leaders from three regions of Qatar, and a small number of doctors (including an anaesthetist, an intensivist, a neurologist, and a physician), reflecting the limited number of clinicians involved in organ donation within Qatar’s single transplant centre. In total, 16 focus group discussions and 13 stakeholder interviews were conducted. All data were transcribed and translated verbatim and analysed using Framework Analysis.
Findings: Overall, the findings show that decisions about organ donation are shaped by a complex interaction of individual awareness, family authority, community norms, religious interpretation, and trust in healthcare systems, with clear differences by nationality, gender, and country of residence. Across groups, higher awareness, visibility of national campaigns, and trust in state-endorsed religious and healthcare institutions, particularly in Qatar, facilitated acceptance of organ donation, while limited exposure, fragmented information, along with misinformation, and conflicting religious messages, especially within UK diaspora communities, acted as key barriers. Family influence and emotional considerations were central across all contexts (both in the UK and Qatar), often overriding individual willingness, with women more likely to defer to family decision-making. Stakeholders highlighted misunderstandings of brain death, cultural and religious sensitivities, and the importance of timely, private, and culturally competent communication with families.
Conclusion: This research demonstrates that organ donation decision-making among minority ethnic populations is not driven by individual knowledge alone, but is embedded within intersecting familial, religious, community, and healthcare contexts. Trust in healthcare systems and religious authority, visibility of culturally sensitive public campaigns, and early engagement with families emerged as critical facilitators, but fragmented religious guidance, misinformation, and limited community-level engagement contributed to persistent uncertainty and reluctance. Overall, the findings highlight that equitable organ donation policies and interventions must move beyond awareness-raising to address structural trust, culturally grounded religious engagement, and community-specific barriers, particularly within minority ethnic and migrant populations.
The second objective explored similarities and differences in perspectives on organ donation among Muslim individuals living in Qatar and the UK, situated within distinct social contexts. Participant nationalities were limited to Qataris and Egyptians (Arab Muslims) and Pakistanis and Bangladeshis (non-Arab Muslims), as these groups represented the two largest Arab and non-Arab Muslim populations in Qatar. The third objective involved semi-structured interviews with key stakeholders working within the Qatari organ donation system. Stakeholders involved in organ retrieval were excluded. Participants included public educators involved in national organ donation campaigns, transplant coordinators, religious leaders from three regions of Qatar, and a small number of doctors (including an anaesthetist, an intensivist, a neurologist, and a physician), reflecting the limited number of clinicians involved in organ donation within Qatar’s single transplant centre. In total, 16 focus group discussions and 13 stakeholder interviews were conducted. All data were transcribed and translated verbatim and analysed using Framework Analysis.
Findings: Overall, the findings show that decisions about organ donation are shaped by a complex interaction of individual awareness, family authority, community norms, religious interpretation, and trust in healthcare systems, with clear differences by nationality, gender, and country of residence. Across groups, higher awareness, visibility of national campaigns, and trust in state-endorsed religious and healthcare institutions, particularly in Qatar, facilitated acceptance of organ donation, while limited exposure, fragmented information, along with misinformation, and conflicting religious messages, especially within UK diaspora communities, acted as key barriers. Family influence and emotional considerations were central across all contexts (both in the UK and Qatar), often overriding individual willingness, with women more likely to defer to family decision-making. Stakeholders highlighted misunderstandings of brain death, cultural and religious sensitivities, and the importance of timely, private, and culturally competent communication with families.
Conclusion: This research demonstrates that organ donation decision-making among minority ethnic populations is not driven by individual knowledge alone, but is embedded within intersecting familial, religious, community, and healthcare contexts. Trust in healthcare systems and religious authority, visibility of culturally sensitive public campaigns, and early engagement with families emerged as critical facilitators, but fragmented religious guidance, misinformation, and limited community-level engagement contributed to persistent uncertainty and reluctance. Overall, the findings highlight that equitable organ donation policies and interventions must move beyond awareness-raising to address structural trust, culturally grounded religious engagement, and community-specific barriers, particularly within minority ethnic and migrant populations.