Table 2 Synthesis of included studies following domains

Medical ethics curriculum in Saudi Arabia

Ethics is an emerging discipline in many medical schools in the Islamic world, being taught in some schools by non-specialists with limited experience in teaching ethics and not housed in proper ethics departments. Teaching medical ethics at the undergraduate level will expand the knowledge of the standards of professional conduct and prepare the graduates to face the ethical dilemmas arising from progressive advances in medical practice and science applications. In the Islamic world, medical school curricula should contain a study of the Islamic code of medical ethics. Islamic law is a compendium of ethics, morality, and legal rules. Islam considers medical ethics the same as ethics in other aspects of life. The syllabus should be logical and practical, parallel to the basic medical study program (Chamsi-Pasha & Al-Bar, 2016)

Al-Haqwi, and Al-Shehri [22]

Medical students (n = 41) from Riyadh

Strong agreement on the importance of learning the principles of medical ethics

To a lesser extent, the contents of the course were relevant to Saudi culture

A disagreement with the view that medical ethics was just common sense

Participants could not decide whether the assessment methods were appropriate or not

Darwish and Sabra [23]

Medical students (n = 164) from Dammam

None of the students had received ethics courses in their basic study

Only a few attended training courses about medical ethics

The majority recognized that disclosure of patient information by a doctor is allowed if it would be beneficial to the society

The majority wrongly mentioned that patient information can be disclosed to a third party without the patient's consent

Aldughaither et al. [24]

Medical students (n = 250) from Riyadh

The majority were satisfied with the course and timing of medical ethics

The method of instruction should be changed to case-based teaching

Ethical issues based on Islamic Fiqh should continue to be discussed

The majority wished to discuss issues related to the doctor-patient relationship and professionalism

Preferred topics were brain death, organ transplantation, cosmetic surgery, abortion, terminal care, reproduction, doctors’ rights, end-of-life issues, and medical errors

Al Kabba et al. [25]

14 public medical schools in Saudi Arabia

All schools had a curriculum dedicated to medical ethics

Six schools had no ethics departments; three had a separate ethics department, five taught ethics as part of another department—family or community medicine

Thirteen schools made learning medical ethics compulsory for students; five schools had taught ethics as an independent course; four as part of another course

Lack of guidance on how to develop a uniform curriculum that addresses both the religious aspects and the practical professional aspects that are sourced from western or other non-Islamic sources to prepare the graduates to practice in non-Muslim countries, as well as dealing with non-Muslim patients

Medical licensing bodies should establish benchmarks to guide the medical schools in the formulation of their curricula

El-Sobkey et al. [26]

Health professions’ students (n = 239) from Riyadh

The majority believed in the ineffectiveness of patient’s rights

Half of the sample had perceptual knowledge about the Saudi Patient’s Bill of Rights (PBR)

Only a few participants knew some items of PBR

Only one course within the curriculum was related to patient’s rights

Alyousefi et al. [27]

Students (n = 247) from Riyadh

Participants could recognize the ethical issues indirectly reflecting moral sensitivity

The majority were able to utilize the ethical principles they learned during the course and apply these principles for the analyses of the cases

Participants were able to recognize, analyze, and criticize unethical and unprofessional behaviors

Participants had less experience in issues such as end-of-life, brain death, assisted reproduction, DNR

Ghamri and Al-Raddadi [28]

Residents (n = 88) from Jeddah

The majority agreed that ethics should be taught in the residency curriculum

Less than half agreed that there were no right/wrong answers to ethical questions

The majority agreed that ethics is a discipline with its methods, literature, vocabulary, and content

The majority disagreed with the statement that training in ethics did not help residents deal with ethical conflicts

Only a few of participants agreed that the training was adequate to handle the ethical conflicts they were likely to face

AbuAbah et al. [29]

Doctors (n = 200) from Riyadh

The majority received only theoretical teaching on ethics during medical school

Theoretical teaching does not address the practical dilemma after graduation

The majority knew about the policy on DNR decision making, orders, and documentation

A lack of knowledge about organ donation regulations, withholding or stopping mechanical ventilation, conflict with family, and advice from the ethics committee

The majority required clear guidelines to make appropriate ethical decisions

Alnajjar et al. [30]

Students (n = 113) from Jeddah

More than half of the participants understood the concept of brain death

Uncertainty on whether brain death was synonymous with the patient demise

The majority was aware of the importance of organ donation

Alotaibi et al. [31]

Dental researchers (n = 660) from dental colleges of Saudi Arabia

A lack of knowledge in research ethics and need to attend courses/ workshops

The importance of teaching research ethics as a mandatory course and training all specialists in research ethics

Positive attitudes towards ethics committees to review human research projects

Doctor-patient relations

At the core of any successful doctor-patient interaction is trust. Integrity and honesty are necessary to achieve the trust of patients. Patients do not expect perfection in their care providers but need to know that their doctor is reliable and trustworthy. As communicators, doctors effectively facilitate the doctor-patient relationship and the dynamic exchanges before, during, and after the medical encounter (Saudi Commission for Health Specialties, 2015)

Alghanim [32]

Patients, doctors, and nurses (n = 799) from Riyadh

More than three quarters of patients and one-third of doctors and nurses did not know about PBR

Those who knew about PBR had little knowledge about the bill contents

Health personnel dissatisfaction, insufficient number of staff, and lack of essential facilities in primary health care centers were obstacles in implementing PBR

Al Qarny et al. [33]

Health care workers (n = 224) from Taif

Almost half of the participants had little knowledge regarding medical ethics in general

Nurses reported more significant knowledge of medical ethics compared to doctors

The majority knew that every patient must be treated with honesty and dignity

Illegal pregnancy abortion cannot be recommended

Patients with high socioeconomic class should not be treated with special care

The majority knew that confidentiality should be kept and the patient should always be told if something was wrong

Children should never be treated without the consent of their parents or guardians (except in an emergency)

Almost two-thirds knew that doctors and nurses should not refuse to treat patients who behave violently

Al-Yousefi [34]

Doctors (n = 225) from Riyadh

The majority reported the positive influence of religion on health and in coping with diseases

Religion rarely/never causes guilt, anxiety, or other negative emotions that lead to an increased patient suffering

Patients frequently used religion to avoid taking responsibility for their health

Family doctors were more likely to initiate religious discussions

Doctors with intrinsic religiosity were more likely to share their religious views

Al-Mohaimeed and Sharaf [35]

Doctors (n = 458) from Qassim

Most doctors did not avoid telling their patients bad news

Almost half of the hospital doctors and a third of PHC doctors believed that the patient has the right to know the diagnosis

Doctors found it easier to speak to the relatives of patients than the patients

Doctors with higher qualifications had lower total scores in breaking bad news

Saleh and Khereldeen [36]

Doctors (n = 246) from Mecca

All participants indicated that the right to know the name of a doctor, to be treated with care and respect, the right to know treatment alternatives is among patient’s rights

Most doctors were aware of patients’ rights to respect, privacy, and confidentiality

A few participants reported that patients' rights were maintained

A few participants agreed that patients have the right to access their medical records

Fayez et al. [37]

Health care workers (n = 370) from four tertiary hospitals in Saudi Arabia

The majority agreed that unethical behavior occurred in their workplace

Confidentiality was compromised, informed consent was not being handled properly, and bad news was not delivered with the care it requires

Doctors lacking empathy, patient autonomy was not fully respected

Discrimination at the workplace

Senior staff does not give enough consideration to ethical issues related to patients

The residents were more likely to agree that unethical behaviors occur than staff

Al Shahrani et al. [38]

Patients (n = 72) from Abha

The highest satisfaction rank was with the patient’s expectations of treatment results followed by the work environment and reception and doctor-patient relationship

Patients were delighted with the technical aspects of the treatment

Most patients were dissatisfied with the explanation of the procedure during treatment

Al-Zahrani et al. [39]

Primary health care doctors (n = 70) from Riyadh

The majority thought that lack of training, cultural norms, gender difference, and lack of time were the main barriers to applying effective communication with patients

Using non-verbal cues to communicate with patients were used rarely

There was no correlation between knowledge and practice of communication skills

Doctors who consciously applied the communication skills in their practice scored better in daily practice

Specialized and MBBS/MD doctors were more confident in their self-rating of communication skills

The majority of residents evaluated their communication skills with lesser self-confidence

Al Ali and Elzubair [40]

Attendees (n = 374) & Doctors (n = 27) from Dammam

Attendees’ satisfaction with doctors’ empathy was not high

Elderly attendees and those with little education indicated greater satisfaction than younger and more educated attendees

A specialty of the doctor-affected communication and patient satisfaction

Family doctors were more closely linked to rapport building, psychosocial exchange, and patient-centeredness

The high professional status of a doctor was positively related to satisfaction with doctors’ empathy

Banaser et al. [41]

Adult patients (n = 22) from Riyadh

The majority were optimistic about their experiences in a doctor-patient relationship

Many recommended doctors and nurses should improve their interpersonal skills and take a more holistic, patient-centered approach

Information provision was problematic for some participants who reported long delays

Privacy was a significant area of concern for participants, especially females

Aljughaiman et al. [42]

Adult patients (n = 229) from Dammam

A high level of patient satisfaction was observed

Patients were more satisfied with the treatment received in public than in private hospitals

The majority were satisfied with the explanation regarding treatment procedures and prompt answering of their queries in public than private hospitals

Alghabiwi et al. [43]

Adult patients (n = 253) from Riyadh

The overall level of satisfaction in a doctor-patient relationship was less than moderate

Patients perceived self-efficacy was significantly associated with the patient’s level of satisfaction with the doctor-patient relationship

Participants with higher satisfaction with the relationship had a stronger sense of self-efficacy in managing their chronic illnesses

Trustworthiness was the item that received the lowest score

Agreement with the doctor on the nature of the medical symptoms received the highest score

Elagi et al. [44]

General public (n = 830) from Jazan

The majority were aware of the principles and essential role of family medicine, health conditions that family doctors can treat, and conditions they do not treat

More than half of participants preferred first to seek healthcare from specialists from other specialties

Although participants were generally satisfied with having a family doctor involved in their care, only a few had a positive experience with family doctors

Nearly a quarter complained of extended visits and long waiting times in family medicine clinics

Fothan et al. [45]

Medical Students (n = 210) from Riyadh

Overall, students demonstrated attitudes that favored patient-centeredness

There were no statistically significant differences identified between students’ demographics and Patient-Practitioner Orientation Scale (PPOS) scores

Almoallem et al. [46]

Doctors (n = 455) from Riyadh

Disagreement among patients/family and doctors about treatment decision

Treating patients with impaired or uncertain decision making

Conflict with administration policies and procedures

Scarcity of resources in the clinic

Uncertainty whether to disclose the diagnosis to the patient by delivering bad news

Conflict on the appropriateness of deciding on a “no-code status” with family or colleagues

Improperly taken informed consent

Female doctors were less confident about their knowledge of ethics

Habbash [47]

Resident doctors (n = 210) from Abha

Older residents have higher scores in communication skills

The female gender was associated with the best ability to ask questions

Years of clinical experience were closely related to better communication skills

Communication skills were affected by the level of residency and attendance at training

Al-Shehri et al. [48]

Resident doctors (n = 261) from Aseer

There was a gap in knowledge of medical ethics

The aspects of confidentiality were generally well understood

Residents responded favorably to questions regarding beneficence and nonmaleficence

It was confusing to decide whether to always agree to the patient’s wishes or act in the interest of the patient despite their refusal

Most participants supported informed consent

Alack of knowledge about abortion ethics and legislation

Most of the participants agreed to the refusal of examination of a female patient by a male doctor in the absence of a chaperone

Negative attitude for earning a commission by referring patients for investigations or taking gifts/ incentives from drug companies

Aljaffary et al. [49]

Patients (n = 345) from Saudi Arabia

Doctors working in public hospitals were more likely to have a higher level of patient trust compared to private hospitals

Patients with “good” self-assessment health status showed a higher level of trust

Patients who were treated in private hospitals had a significantly lower score of self-assessment health status than those who were treated in public hospitals

Informed consent

Before delivering medical treatment or carrying out an operative procedure, the legally competent patient’s consent, be he/she male or female, shall be obtained. The doctor shall provide an adequate explanation to the patient or his/her guardian on the nature of the medical treatment or operative procedure he intends to apply (Saudi Ministry of Health,1988)

Al Qarny et al. [33]

Health care workers (n = 224) from Taif

Support for informed consent by health care workers

Most participants knew that patients should always be told if something was wrong

Children should never be treated without the permission of their parents or guardians (except in an emergency)

Almost two-thirds of participants knew that patients not only need to consent for operations but also for tests and medications

Abolfotouh and Adlan [50]

Adult patients (n = 162) from Riyadh

The overall attitude towards informed consent was positive

Poor quality of informed consent in terms of experience with the informed consent processes and the transparent delivery of information regarding risks

More than half of the study sample trusted the doctor to decide on behalf of them

Many participants were not interested in obtaining a copy of the informed consent

Quality of scholarly consent score was higher when explained by the doctor and among younger patients

Darwish and Sabra [51]

Medical interns (n = 87) from Dammam

The majority could recognize the meaning of general and specific consent

The majority agreed that consent should be given for each new procedure and should be perceived as a continuing process rather than a one-off decision

The majority decided that surgeons could exceed the consent in case of emergencies and the absence of a guardian

Less than half of the participants agreed that the patient is allowed to look into his medical record or take a copy of it if asked for that

Fayez et al. [37]

Health care workers (n = 370) from four tertiary hospitals in Saudi Arabia

The majority agreed that unethical behavior occurred in their workplace

The confidentiality of patients was compromised

Informed consent not handled properly

Hammami et al. [52]

Adult patients (n = 488) from Riyadh

The informed consent process was essential to patients

Males, pre-procedure, and older patients more favor a self-decision-making purpose

Females and post-procedure patients more turn an information disclosure purpose

More self-decision-making and more effective information disclosure was desired

Mill’s autonomy model of informed consent is preferred, which may be suitable for most patients, especially males and older patients

Some patients showed a degree of dissatisfaction with the informed consent process

Almohaimede et al. [53]

Patients (n = 138) from Riyadh

Dissatisfaction among patients regarding the experience of the informed consent process

Lack of knowledge about the risks of the intervention and alternative management

Half of the participants wished to be involved in decision-making

One third had no time to comprehend the information provided

A higher quality of informed consent was predicted when explained by the doctor

About half of the participants believed that their decision was not necessary because the doctor had already decided for them

Alsaihati et al. [54]

Surgeons (n = 140) from Saudi Arabia

Participants had acceptable knowledge about informed surgical consent

The majority did not give full details to patients about the procedure before taking consent

There was a careless approach in the consent process among surgeons

Some considered consent as only a pre-operative routine or just signing the paper

Some believed that the consent process is strange to Saudi psychology

The majority were against applying for a license during all surgical procedure

Mahrous [55]

Patients or family members (n = 176) from Madinah

There is a low level of awareness of patients’ rights

The consent form followed by complaint registration against a service provided was the best-known patients’ rights variable

About half of the sample had never heard about patients’ rights

More males, compared to females, signed a consent form upon hospital admission

Basharaheel et al. [56]

Surgical doctors (n = 188) from Jeddah

The majority had experience in obtaining informed consent for a surgical procedure

Senior doctors were the main doctors taking informed consent from patients

Interns were least exposed to observing surgical procedures than other team members

Interns were the least comfortable while taking consent

Alahmad et al. [57]

Nurses (n = 17) from Riyadh and Jeddah

Participants considered parental consent mandatory and necessary from the moment the child is admitted to the hospital and during treatment

Consent should be easily understandable and have the required information decision

Obtaining consent from the child’s father reflects a cultural difference between Saudi Arabia and other Middle Eastern countries

Alsaidan et al. [58]

Patients (n = 246) from Al-Kharj

About 30% of cosmetic procedures were performed without taking informed consent

Quality of informed consent was generally poor, both in content and administration

Issues related to lack or poor consent are getting focused only when the procedure ends up with adverse events or non-satisfactions but without actual association

Alahmad et al. [59]

Doctors, nurses, parents, and medical students (n = 400) from Dammam, Riyadh, and Jeddah

The majority preferred both parents to give consent, followed by either parent without differentiation between parents

The majority preferred that parental consent forms be detailed enough to obtain the maximum information

The majority preferred that the form seeking to obtain the permission of the child be short, not to increase the burden on the child since the decision belongs to the parents

Most participants preferred to rely on a child's level of maturity rather than having reached a certain age so that they could give consent

A few participants considered the age of 13–14 suitable for a child to give a consent

Do-not-resuscitate

Fatwa 12,086: this fatwa stipulates that judging resuscitative efforts to be of no avail and issuing a do-not-resuscitate (DNR) order is done by three “specialized and trustworthy” doctors and that the patient’s family or legal guardian is not to be consulted when it comes to issuing the order (General Presidency of Scholarly Research and Ifta in Riyadh, 1998)

Aljohaney and Bawazir [60]

Residents (n = 157) from Jeddah, Makkah, Madinah, and Taif

Most residents participated in DNR discussions with patients and family or surrogate decision-makers

The most common limitation to meaningful DNR discussions was a lack of understanding of the patient, the patient’s family, or surrogate, followed by inadequate training

Most residents believed that additional educational programs would enhance their competence in addressing issues related to DNR discussions

Need for a structured curriculum to teach skills relating to end-of-life issues such as DNR orders to residents in the Saudi medical system

Amoudi et al. [61]

Interns and residents (n = 140) from Jeddah

A lack of familiarity with DNR policies in local hospitals

Residents were more familiar with DNR

Participants failed to affirm whether a clear local or national DNR policy exists

Participants believed that the patient should be part of the decision-making process

Al Sheefet al. [62]

Outpatients/caregivers (n = 307) from Riyadh

Half of the participants could define DNR order

The majority required more in-depth knowledge

The opinion of the participants regarding the compatibility of DNR order in terms of religion and ethics was divided due to ethical, religious, and medical factors

Gouda et al. [63]

ER & ICU doctors (n = 112) from Riyadh

Most of the participants were aware of the existence of the DNR policy

Two-thirds of the participants did not read the detailed policy

The majority were in favor of having a DNR for themselves in case of a terminal illness

The majority preferred the DNR order to be a doctor-directed decision

Every patient should have advance directives

The most important barriers for initializing and discussing DNR were lack of patient understanding, level of education, and the cultural background of patients

Most Muslim doctors believe that DNR is not against Islamic rules

Madadin et al. [64]

ICU doctors (n = 42) from Al Khobar

Participants were aware that DNR in Saudi Arabia is legal

Cultural standards and religious beliefs do play a role in their decision-making but had less of an effect as compared to other clinical data such as comorbidities, age, and previous ICU admissions

Baharoon et al. [65]

Patients (n = 300) from Riyadh

A lack of knowledge of the medical condition, advanced planning, and life support

A will to participate in end-of-life care planning discussions with doctors

The majority were able to make intelligent judgments about end-of-life decisions

Limited knowledge of CPR or mechanical ventilation

90% of participants formed an opinion about the desirability of intensive care

Kaneetah et al. [66]

Adult patients and the general public (n = 1,693) from Mecca

Most participants wanted to be involved in the decision-making on DNR

The majority had a lack of knowledge about the DNR practice

A background in medicine and knowledge about DNR was associated with the acceptance of DNR

The most common reasons for refusal DNR were of hope and religious concern

Alsaati et al. [67]

Medical students (n = 429) from Jeddah

The majority believed that there is a Fatwa that regulates DNR on the Islamic level

Most of the participants were familiar with the DNR order

Lectures in the medical schools on DNR were the primary source of information

The majority of participants were not sure if there is a clear policy concerning DNR policy at King Abdulaziz University Hospital (KAUH) in Jeddah

Lack of DNR understanding in patients and their families is one of the most important barriers that impede an effective DNR discussion

The majority strongly agreed that patients should be involved in DNR decisions

Al Farhan et al. [68]

Patients (n = 72) from Riyadh

DNR orders were associated with a reduction in doctors providing clinical care

The drop-in care after DNR was seen only among doctors rather than nurses

Doctors need more insight into the true goals of DNR orders and should not equate them with withholding other therapeutic interventions

Al Ahmadi et al. [69]

Participants (n = 400) from Jeddah

Participants with higher educational levels were more familiar with the DNR term

DNR was poorly understood due to religious and cultural factors

There were no significant differences among age, gender, and responder status

The majority of participants chose doctors like the one responsible for the DNR decision

Aljethaily et al. [70]

Pediatricians (n = 203) from Riyadh

The majority could not define DNR correctly

DNR policy and procedure were not clear to them

Half of the participants believed that DNR was a doctor’s decision

The majority felt that patients had the right to intensive care, despite terminal illness

A few of samples reported that they would be comfortable discussing DNR with parents

Almoallem et al. [46]

Doctors (n = 455) from Riyadh

Non-Saudi doctors deciding on life-sustaining treatment or DNR consulted with the ethical committees more frequently than Saudi doctors

Doctors who received their education and postgraduate training abroad were confident about their ethics knowledge in medical practice but had less confidence in making decisions about life-sustaining treatment or DNR orders

Consultants compared with non-consultants had more knowledge about ethics, less conflict with family, and were at ease in making decisions about DNR or end-of-life

Female doctors were less confident about making decisions about life-sustaining treatment or a DNR order

Abu Yahya et al. [71]

Nurses (n = 157) from Riyadh

Most of the nurses wanted there to be a legal basis for DNR policies

The majority stated that they wanted to know more about patients’ rights regarding the end-of-life and use of the DNR order

The majority agreed that DNR orders support the treatment plan for terminally ill patients

Organ donation & transplantation

Fatwa No. 99: The Saudi Grand Ulema (1982) addressed the subject of organ transplants, which was unanimously sanctioned. It also sanctioned (by the majority) the donation of organs both by the living and by the dead, who made a will or testament, or by the consent of the relatives (who constitute the Islamic next of kin). The regulations in Saudi Arabia initially restricted genetically related donors or spouses, but many of these restrictions were later removed (Saudi Grand Ulema, 1982)

Alghanim [72]

Residents (n = 897) from Saudi Arabia

Participant from rural areas was less likely to have information about organ donation than their counterparts in urban areas

More than half of the rural respondents and more than 40% of the respondents living in the urban areas were not willing to donate organs and sign organ donation cards

The main source of information about organ donation was a TV

The majority reported that the contribution of health care providers in providing them with knowledge about organ donation and transplantation was “none” or “little”

Reasons for refusal to donate were worries about receiving inadequate health care after donation, lack of family support, lack of incentives, not enough information about organ donation, fear of complications after organ donation, religion

Hammami et al. [73]

Adults (n = 698) in the outpatient setting from Riyadh

Most respondents were in favor of posthumous organ donation

The mandated choice system was the most preferred

The presumed consent system was the least preferred

Financial and medical incentives had a negative effect with a predominance of altruistic motives and belief in the sanctity of the body

No association between favoring a consenting system and age, perceived health status, education level, or knowing an organ donor or recipient

Mohamed and Guella [74]

Adults (n = 497) from Dhahran

The level of awareness of transplantation and organ donation was high

The main obstacle related to the concept that having one kidney may only expose the donor to potential medical problems

Religion was not an obstacle

Harthi and Alzahrany [75]

Students (n = 400) from Taif

Almost one-third of the participants reported that they had insufficient information about organ donation and transplantation

No significant association of the willingness to donate with gender or age

The main source of information regarding organ donation was media, mainly television

Participants who did not encourage organ donation were concerned about fearing complications and not receiving adequate health care after donation

Soubhanneyaz et al. [76]

Adults (n = 461) from the Western province

The majority knew well which organs could be donated

There was a lack of knowledge about the regulations and legislation of organ donation

The majority were willing to donate organs with no significant differences in males and females

Religion, money, and age of the recipient appeared to have no role in their will of organ donation

Participants believed that governmental incentives in the form of monetary and health treatment for donor families and awards would be effective in promoting organ donation

Almohsen et al. [77]

Students (n = 195) from Qassim

The primary source of knowledge on organ donation was a television

The majority believed that there is low public awareness regarding the subject

One-third of students knew about organ donation cards, but none had signed, due to fear of side effects

There were misconceptions of the Islamic perspective, resulting in fewer donors

Medical students showed higher knowledge about organ donation cards and the effectiveness of transplantation as treatment compared to non-medical students

Al Bshabshe et al. [78]

Students (n = 873) from Abha

The majority (92.4%) did not know the religious point of view about brain death and had not heard of any existing decree or Fatwa regarding brain death in Saudi Arabia

Almost half would accept the concept of brain death if one of their relatives had it

The majority received their information about brain death from the media

The majority had the impression that there is no difference between brain death and natural death

Hajjar et al. [79]

Social media users (n = 913) from Saudi Arabia

The majority received information about organ donation from TV and social media

The contribution of healthcare providers as a source of information was minimal

An increase in the knowledge of the religious legislation (Fatwa) of organ donation

More than half of the participants were willing to donate their organs

Reasons for refusal were poor knowledge about organ donation, insufficient support of healthcare providers, religion, lack of family support, and fear of operations

AlHabeeb et al. [80]

Adults (n = 1298) in 18 cities of Saudi Arabia

Participants accepted the concept of organ donation and were willing to donate

Concerns remain on heart donation

Almost a third of participants expressed a fear that healthcare professionals may make less effort to save the lives of potential donors

Elsafi et al. [81]

Allied health students (n = 434) from Dhahran

Overall knowledge of organ donation was adequate

The majority were willing to be living donors for their families

A few participants supported deceased organ donation and thought about an organ donation card

The most frequent cause of refusal to donate organs was the mistrust of medical staff regarding brain death diagnosis

Bodily concerns and religion were additional concerns

Quite a few of respondents supported commercial donation

The reason to donate organs was to help others and sympathy

The main source of information was television, relatives/friends, and the Internet

Sayedalamin et al. [82]

Students (n = 481) from Jeddah

The majority showed a positive attitude towards organ donation

There were few misconceptions and a lack of knowledge about organ donation, such as organ grafting from a male to a female or vice versa

The two-thirds were in favor of brain-dead patients donating their organs

Less than half were ready to donate their organs

Reasons of refusal to donate were family consent; some wanted to keep all their organs intact, religion and medical history

The majority knew about organ donation from the media

Agrawal et al. [83]

Adults (n = 403) from Al-Kharj

Nearly half of the respondents believed that religion does not allow for organ donation

Less than 3% knew the correct place to go for organ donation

Participants with more knowledge were more willing to donate their organs

Al Bshabshe et al. [84]

Students (n = 649) from the Southern province

The knowledge regarding brain death and organ donation was found to be poor

More than half of the participants have not heard about the term “brain death”

Less than half of participants were in favor of organ donation from a brain-dead person, ready to donate the organs of a family member or a relative who is brain dead, willing to donate their organs

Al-Hussain et al. [85]

Adults (n = 409) from Riyadh

More than half of the participants were aware of brain death

The majority stated that it was acceptable to donate, according to religion

More than half would agree to donate their organs in case of brain death

The majority would donate their organs without discussing them with families or friends

Almufleh et al. [86]

Residents (n = 2,596) from Riyadh

The level of organ donation awareness was high

Organ donation awareness was found to be more in females, educated individuals, those with higher socioeconomic status, and married participants

More than half of the sample expressed willingness to donate brain-dead relatives’ organs

Reasons for refusal to donate were body disfigurement, religion, unawareness, and family disagreement

AlHejaili et al. [87]

Students (n = 821) from Saudi Arabia

The majority has sufficient knowledge of organ donation and transplantation

The degree of awareness positively impacted the willingness to donate

Commonly cited the reason as a barrier to donation after death was the fear of premature termination of medical treatment to facilitate organ retrieval and transplantation

Females scored higher than males in both the awareness and altruism

Alsharidah et al. [88]

Adult Saudis (n = 648) from Riyadh

The majority knew the concept and procedure of organ donation

The majority agreed to sign donation cards by reasons of faith, good deed, importance of donation, and belief that organs are not beneficial after death

Religion was not a barrier

There was a lack of awareness about the Saudi Center for Organ Transplantation (SCOT)

Aziz et al. [89]

Adults (n = 350) from Aseer

Participants showed an acceptable level of awareness about organ donation

A generally positive attitude towards organ donation for any person regardless of age, religion, mental status, or health status

Doctors' role as a source of information was poor

Internet and mass media played the highest role as a source of information

Alruwaili et al. [90]

Paramedical and medical students (n = 350) from Saudi Arabia

Eye donation awareness and willingness to donate are generally low in Saudi Arabia

Less than 7% of medical students knew of the existence of eye banks

Hazzazi et al. [91]

Students (n = 744) from Jazan

A lack the knowledge on hematopoietic stem cell transplantation (HSCT)

Participants who registered in the Saudi stem cell donor registry (SSCDR) had better knowledge and attitudes towards HSCT than unregistered participants

Long-term side effects of HSCT were the most common concern of the participants

The time commitment was the main concern of the registered students

Alnasyan et al. [92]

Adults (n = 1453) from Saudi Arabia

A positive attitude toward organ donation among the majority

High rate of willingness to donate correlated to the high rate of educated participants

The majority believed that consent should be acquired from the donor

The level of knowledge about SCOT was as low as 12.6%

Alanazi et al. [93]

Residents (n = 1292) from Saudi Arabia

The majority had no sufficient information about corneal donation and did not know how or where to apply to register as a cornea donor

A significant correlation between participants’ knowledge and willingness to donate

The largest perceived barrier was the lack of information on where to donate or register as donors

The main motive to donate was the religious belief of doing good and being charitable with their organs

Almutairi [94]

Students (n = 425) from Central province

Medicine and physiotherapy students in their final year scored higher knowledge, attitudes, and willingness towards organ donation compared to dentistry, nursing, and paramedical counterparts

Females scored higher than males in all the three domains of knowledge, attitude, and willingness toward organ donation

Alnajjar et al. [30]

Students (n = 113) from Jeddah

The majority were aware of the importance of organ donation

More than half of the participants expressed a willingness to donate the organs of family members if they were to be diagnosed with brain death

Alibrahim and Jindan [95]

Adults (n = 1001) from Eastern Province

Participants had poor knowledge about corneal donation

Less than one-third were favorable to postmortem corneal grafts

Religion hindered the willingness to donate in about one-quarter of the sample

Kazzaz and Da’ar [96]

Pediatric intensivists (n = 100) from Central, Eastern, Northern, Western, Southern regions

Low perceived comfort levels in several organ donation competencies

Comfort levels were influenced by the participants’ frequency of exposure to donation after brain death, the health sector, and region of practice

Participants viewed most of the competencies as important to their practice

Low comfort levels with competencies were associated with gaps in knowledge

Thirunavukkarasu et al. [97]

Students (n = 400) from Jouf

The most common organ that can be donated are kidneys, blood, heart, and eyes

About two-thirds were not aware of SCOT and its activities

The government has to promote organ donation to the public

The majority were willing to donate their organs

Common barriers for organ donation were a lack of knowledge, founded and unfounded fear, and refusal from family members

Omran et al. [98]

Students (n = 352) from Jeddah, Mecca, and Taif

Most of the sample had poor knowledge about organ donation

Higher knowledge in sixth-year students than second-year students

The majority had an appropriate attitude about organ donation

Altraif et al. [99]

Adults (n = 376) from Riyadh

A correlation between higher educational level, the knowledge of brain-dead donation, and the Islamic point of view

More than half have heard about SCOT

Health-related occupations showed more awareness about organ donation, SCOT, and willingness to donate their families’ organs

The main barrier for organ donation was lack of information, belief that organ donation disfigures the body and that donated organs can be misused or abused

Most of the respondents preferred donating to young people

Gelidan [100]

Adults (n = 698) from Riyadh

Almost all age groups knew about organ donation after death, with male prevalence

Participants with higher education were more aware of organ donation

Females were more enthusiastic and had significantly high acceptance of skin donation as compared to males

Religious factors were the most common reason to refuse skin donation

Darwish et al. [101]

Adults (n = 1508) from Saudi Arabia

The majority supported organ donation

More than half were willing to donate any organs

The majority did not know the organ donation policies

Al-Oufi and Alghamdi [102]

Adults (n = 670) from Madinah

The majority showed high levels of knowledge about blood donation but poor knowledge about organ donation

The majority of participants showed negative attitudes towards organ donation

The main source of knowledge were friends and family

Knowledge was depended on the education and occupation

Bukhari [103]

Adults (n = 1099) from Saudi Arabia

Saudi population was willing for organ donation in general and in specific conditions

Females were more willing to donate their solid organs than males

The donation was more likely among the young population