Organ donation is a completely voluntary behavior that can save the life of a person unknown to the donor. Organ donation rates vary across the world. According to the International Registry in Organ Donation and Transplantation (2022), Türkiye ranks first in the world for organ donations from living donors. The rate of organ donation from living donors is 56.00 donations per million residents, while the rate of organ donations from deceased donors in Türkiye is much lower, 3.40 donations per million (International Registry in Organ Donation and Transplantation, 2022). The examination of the statistics according to the World Health Organization regions has shown that 36.7 kidney transplants are performed per million people in the European region and that only 32% of these transplants are performed with organs from living donors. Also, 14.3 liver transplants are performed per million people in the European region and 18% are performed with organs from a living donor (Global Observatory on Donation and Transplantation, 2022). In this country, organ procurement from a cadaver can only be done with the permission of the deceased’s family and only 17% of families in Türkiye agree to this (Türkiye Ministry of Health, 2022). Organ donation is an issue that should be considered in terms of its medical, religious, social, economic, cultural, legal and ethical aspects. In addition, special care should be taken regarding the social interactions in and interpretation processes of organ donation and transplantation (Gezginci et al., 2020).

Nurses have important roles and responsibilities in increasing social awareness, caring for organ transplant patients and their donors, identifying and showing respect for dead donors and supporting organ transplant organizations (Krucinska et al., 2020; Scales & Bentley 2020). These are the knowledge and skills that nursing students need to acquire in their education process as future nurses. In studies conducted with nursing students, it was seen that they had very positive attitudes towards organ donation, but very few of them had registered to donate organs (0.4-4%) (Güler et al., 2020; Krucinska et al., 2020; Lei et al., 2018; Söylemez & Ordin, 2017). Nursing students' personal belief, morale, religious belief, state of knowledge and feelings affect their organ donation willingness (Contiero and Wilson, 2019, Martínez-Alarcón et al., 2022). Previous studies focused on different dimensions of religious belief and it was seen that its effect was not clearly expressed. These studies indicated that nursing students’ attitudes toward organ donation were influenced by religious (Soylu et al., 2022) and personal beliefs (Contiero & Wilson, 2019). While some studies showed that religious beliefs affected organ donation attitudes, no relationship was found (Soylu et al., 2022, Ali et al., 2020, Azuri and Tarabeih, 2022).

Although no religion or tradition specifically prohibits organ donation or transplantation, members of certain religious groups may exhibit positive or negative attitudes, depending on their religious understanding (Ali et al., 2020, Azuri and Tarabeih, 2022). Religious concerns appear to be an important factor in shaping individuals’ attitudes toward organ donation. Qualitative research about individuals opposed to organ donation showed that attitudes towards the process were influenced by issues such as the lack of religious permission, religious uncertainty, possible sins that committed in the donation process, the violation of the sanctity of dead body and the belief in the wrongness of disturbing the body (Özbolat, 2017). Many of today's Islamic scholars and fatwa organizations, too, allow organ transplantation from the dead. While the decision of the Religious Affairs High Board of the Presidency of Religious Affairs, dated March 3, 1980 and numbered 396/13, can be cited as an example of fatwas in this direction, it takes time to change the established thoughts in a religious-social structure (Bektaş, 2023). There are two important views in Islam about organ donation. The view supporting organ donation is that human life takes precedence over the respect to be shown for the dead human body. The view that does not support organ donation is that, as expressed in the hadith "breaking the bone of a dead person is like breaking his/her bone while he/she is alive" (Muvatta, Cenaiz, 45; Ebu Davud, Cenaiz, 60), the provision of accepting the human body as respectable is valid for the afterlife as well and that in case of necessity, even if it is to stay alive, the dead body cannot be used. It could be argued that the failure of organ transplants performed under the medical conditions of those periods was effective in the formation of these views (Tarabeih et al., 2022).

Another social variable that might be thought to be as influential as religion in organ donation is sense of citizenship. Citizenship is defined as the relationship between individuals and the state based on mutual rights and duties defined by the constitution and laws (Ulutaş, 2014). Citizenship is a concept that has cultural, economic and social dimensions and is integral to everyday life. An international report on organ donation and transplantation activities in 2021 showed a decrease in organ donor per million people (PMP) and that the ratio differed across countries. The countries with the highest number of deceased organ donors were Unites States, Spain and Iceland, respectively, while Türkiye ranked 46th, with 2.0 PMP (Global Observatory on Donation and Transplantation, 2021). Türkiye’s low ranking could have many psychological, social, legal and economic reasons. One of these is the sense of citizenship, which is an important concept in recognizing global health problems, ensuring social justice and taking responsibility for problems (Reis et al., 2022, Shahzad et al., 2022). Every country has its own organ donation waiting list and donated organs can only be used in transplants in the same country (Bastani, 2020). Thus, the issue of organ donation is to some extent tied to social structure and thus requires community awareness, collective consciousness and the consideration of citizens (Yigit & Tatch, 2017). It can be hypothesized that the sense of citizenship might contribute to the difference between countries in terms of organ donation but no study on this subject could be found in the literature.

Each country should examine the issue of organ donation within its own sociocultural context and propose solutions accordingly. In Türkiye, it is important to understand why the rate of organ donation from deceased donors is so low compared with living donors. In the literature, it appears that no study has examined the effects of religious attitudes and sense of citizenship on organ donation attitudes and willingness was found. No study has been found that examines the relationship between the sense of citizenship and the attitudes towards organ donation. To address this important gap in the literature, the present study, in the context of Türkiye evaluates the effect of (Islamic) religious attitudes and sense of citizenship on attitudes toward organ donation. In this respect, the primary purpose of this study is to examine the relationship between religious attitude, sense of citizenship and organ donation attitudes and organ donation willingness among Turkish nursing students. The secondary purpose is to examine the relationship between demographic variables (age, gender and years of education) and the main study variables (organ donation attitudes and organ donation willingness) among Turkish nursing students.