Background and Purpose: Chronic diseases and road accidents in southeastern Iran have increased the need for organ transplantation. Despite this, the total number of donors is not sufficient. This study examined the knowledge, attitudes, and associated factors regarding organ donation among adults in Khash city, southeastern Iran, over a four-month period from June to September 2023.
Materials and Methods: In this cross-sectional study, 400 individuals from comprehensive urban health service centers in southeastern Iran participated using convenience sampling. Data were collected using a 30-item questionnaire measuring knowledge, attitudes, and willingness to donate organs. Descriptive statistics and multiple linear regression analysis were used in the statistical analysis. 
Results: The mean age of the participants was 28.39±9.07 years. Of the participants, 53% were female and 55.5% were married. Overall, 67% (n=268) of the 400 respondents were willing to donate. Women were significantly more willing than men (60.82%, n=163 vs 39.18%, n=105; P=0.002). The average scores for knowledge, attitude, and willingness among participants were 11.80±2.66, 49.75±6.10, and 3.50±1.23 out of 22, 72, and 6, respectively. The multiple linear regression revealed a positive correlation between attitude and willingness to donate (P=0.047). Gender was also a potential determinant of greater willingness to donate (β=0.181, 95% CI, 0.087%, 0.274%; P<0.001). The most significant predictor of donation willingness was education level (β=0.333, 95% CI, 0.106%, 0.197%; P=0.001). Despite their high willingness, only 19.8% had an organ donation card, highlighting the gap between intention and practice. The most significant key barriers to organ donation included a lack of awareness about the importance of organ donation, fear of surgery and health risks, and criticism and judgment from others.
Conclusion: Attitude, gender, and education level are positively and significantly associated with the willingness of people in southeastern Iran to donate organs. Lack of awareness, fear of surgery, and fear of judgment from others are significant barriers contributing to the low rate of organ donor card registration. To increase the rate of receiving organ donor cards, a multifaceted approach is recommended, including targeted educational campaigns, culture-building, health policy review, and the integration of educational interventions into primary health services.