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jha 2025, 28(2): 1-21 |
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Esmaeili M, Bodaghi Khajeh Noubar H, Gharebeiglou H, Shahinpour A. Family components and touchpoints to increase organ donation within the framework of social marketing: a scoping review. jha 2025; 28 (2) :1-21
URL: http://jha.iums.ac.ir/article-1-4649-en.html
URL: http://jha.iums.ac.ir/article-1-4649-en.html
1- Department of Business Management, Ajabshir Branch, Islamic Azad University, Ajabshir, Iran.
2- Department of Business Administration, Tabriz Branch, Islamic Azad University, Tabriz, Iran ,bodaghi@iau.ac.ir
2- Department of Business Administration, Tabriz Branch, Islamic Azad University, Tabriz, Iran ,
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Figure 1. PRISMA flowchart for the study selection process
Figure 2. Components affecting the family institution in increasing organ donation
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Introduction
The growing global demand for transplantable organs has made consent for organ donation a critical issue for both individuals in need and society [1]. In over 50 countries, including Iran, family consent is a major requirement [2]. In Iran, about 25,000 patients are on the transplant waiting list, and one patient dies every two hours, while 6,000 viable organs are lost annually. Despite these challenges, Iran ranked first in Asia and 30th worldwide in organ donation rates in 2020 [3].
Social marketing—the application of commercial marketing principles to influence target audiences for social good—can play a vital role in increasing donation rates [4] by identifying target groups, their key “touch points,” and related characteristics. In Iran, the lack of a coherent, culturally adapted social marketing system remains a challenge, as promotional efforts have often been fragmented, unstructured, and lacking consideration for cultural and family dynamics. Touch points, defined as all interactions between target audiences and organ donation messages or programs, shape attitudes, awareness, trust, and ultimately willingness to act [5]. Families are a crucial audience in this framework, as their consent significantly influences donation rates. Obtaining consent often occurs under emotionally distressing circumstances [6], which directly impacts their decisions regarding donation [7].
Recent studies have examined factors affecting family decision-making. For instance, Yeung [8] found that combining online videos with interviews increased willingness to donate compared to receiving a single SMS. Grossi et al. [9] highlighted the long-term positive effects of high-quality donation discussions. Lalegani et al. [10] reported that decision-making mediators could have both positive and negative effects. However, most studies have focused on single factors and paid little attention to social marketing role in changing family behavior in the Iranian context.
This study reviews literature from 2020 onwards to ensure up-to-date evidence that reflects post-COVID-19 developments, technological advances, and recent policy changes. Using a social marketing framework, this study identifies and analyzes key family touch points in the organ donation process, proposing strategies to enhance engagement, reduce decision-making barriers, and develop an effective framework for managing family veto.
Methods
This study aimed to identify domains, components, concepts, and key touchpoints for family behavior change in organ donation, a core element of social marketing. A scoping review approach was used to gather studies on family roles in organ donation, following the Joanna Briggs Institute (JBI) guidelines [11] for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) standards.
Literature searches were performed in a variety of databases including PubMed, Scopus, Web of Science, ProQuest, Emerald, SID, Google Scholar, and relevant organizational websites (e.g., World Health Organization, Iranian Organ Donation Association, Organ Donation Center, and Organ and Tissue Procurement Network). Keywords included "organ donation," "organ donor," and family-related terms (search strategy is available in Supplement). Inclusion criteria covered all study types, grey literature, and all languages. Studies were imported into EndNote for duplicate removal, with a focus on publications from 2020 onward to ensure currency, reflecting COVID-19 effects, technological/legal advancements, and alignment with modern policy/decision-making for boosting organ donation rates.
Screening involved title and abstract review, followed by full-text accessibility and content evaluation for inclusion. Non-matched studies were excluded. Validity and reliability were ensured via two independent researchers, with discrepancies resolved using Rayyan software and supervisor input.
Data analysis employed thematic analysis per Braun and Clarke [12]. Full texts were systematically reviewed; key touchpoints and concepts on family roles in organ donation were extracted into an Excel data form. Coding via MAXQDA24 followed these steps: 1) data familiarization through detailed reading and note-taking, 2) generating initial descriptive codes from article key points, 3) searching for themes by grouping codes into shared concepts, 4) reviewing themes for merging or separation, 5) defining and naming themes with textual evidence, and 6) producing a final report of themes as findings. Credibility and validity were enhanced by independent coding by two researchers, agreed-upon merging, and verification of theme alignment with study objectives and conceptual framework.
Results
In this scoping review, 3993 records published between 2020 and 2024 were identified through relevant scientific databases. Following the removal of duplicates, 2048 unique articles remained. During the initial screening of titles and abstracts for alignment with the inclusion and exclusion criteria, 1469 articles were excluded for various reasons. In the full-text screening phase, 340 of the 384 accessible full-text articles were excluded based on the criteria. Ultimately, 44 articles that fully aligned with the objectives of the review were selected for final analysis. An additional 25 relevant articles, identified through manual searching, were also included. The final corpus comprised a total of 69 articles, encompassing quantitative, qualitative, and review studies. Figure 1 (PRISMA flow diagram) visually presents all these stages, ensuring transparency in the selection process.
The growing global demand for transplantable organs has made consent for organ donation a critical issue for both individuals in need and society [1]. In over 50 countries, including Iran, family consent is a major requirement [2]. In Iran, about 25,000 patients are on the transplant waiting list, and one patient dies every two hours, while 6,000 viable organs are lost annually. Despite these challenges, Iran ranked first in Asia and 30th worldwide in organ donation rates in 2020 [3].
Social marketing—the application of commercial marketing principles to influence target audiences for social good—can play a vital role in increasing donation rates [4] by identifying target groups, their key “touch points,” and related characteristics. In Iran, the lack of a coherent, culturally adapted social marketing system remains a challenge, as promotional efforts have often been fragmented, unstructured, and lacking consideration for cultural and family dynamics. Touch points, defined as all interactions between target audiences and organ donation messages or programs, shape attitudes, awareness, trust, and ultimately willingness to act [5]. Families are a crucial audience in this framework, as their consent significantly influences donation rates. Obtaining consent often occurs under emotionally distressing circumstances [6], which directly impacts their decisions regarding donation [7].
Recent studies have examined factors affecting family decision-making. For instance, Yeung [8] found that combining online videos with interviews increased willingness to donate compared to receiving a single SMS. Grossi et al. [9] highlighted the long-term positive effects of high-quality donation discussions. Lalegani et al. [10] reported that decision-making mediators could have both positive and negative effects. However, most studies have focused on single factors and paid little attention to social marketing role in changing family behavior in the Iranian context.
This study reviews literature from 2020 onwards to ensure up-to-date evidence that reflects post-COVID-19 developments, technological advances, and recent policy changes. Using a social marketing framework, this study identifies and analyzes key family touch points in the organ donation process, proposing strategies to enhance engagement, reduce decision-making barriers, and develop an effective framework for managing family veto.
Methods
This study aimed to identify domains, components, concepts, and key touchpoints for family behavior change in organ donation, a core element of social marketing. A scoping review approach was used to gather studies on family roles in organ donation, following the Joanna Briggs Institute (JBI) guidelines [11] for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) standards.
Literature searches were performed in a variety of databases including PubMed, Scopus, Web of Science, ProQuest, Emerald, SID, Google Scholar, and relevant organizational websites (e.g., World Health Organization, Iranian Organ Donation Association, Organ Donation Center, and Organ and Tissue Procurement Network). Keywords included "organ donation," "organ donor," and family-related terms (search strategy is available in Supplement). Inclusion criteria covered all study types, grey literature, and all languages. Studies were imported into EndNote for duplicate removal, with a focus on publications from 2020 onward to ensure currency, reflecting COVID-19 effects, technological/legal advancements, and alignment with modern policy/decision-making for boosting organ donation rates.
Screening involved title and abstract review, followed by full-text accessibility and content evaluation for inclusion. Non-matched studies were excluded. Validity and reliability were ensured via two independent researchers, with discrepancies resolved using Rayyan software and supervisor input.
Data analysis employed thematic analysis per Braun and Clarke [12]. Full texts were systematically reviewed; key touchpoints and concepts on family roles in organ donation were extracted into an Excel data form. Coding via MAXQDA24 followed these steps: 1) data familiarization through detailed reading and note-taking, 2) generating initial descriptive codes from article key points, 3) searching for themes by grouping codes into shared concepts, 4) reviewing themes for merging or separation, 5) defining and naming themes with textual evidence, and 6) producing a final report of themes as findings. Credibility and validity were enhanced by independent coding by two researchers, agreed-upon merging, and verification of theme alignment with study objectives and conceptual framework.
Results
In this scoping review, 3993 records published between 2020 and 2024 were identified through relevant scientific databases. Following the removal of duplicates, 2048 unique articles remained. During the initial screening of titles and abstracts for alignment with the inclusion and exclusion criteria, 1469 articles were excluded for various reasons. In the full-text screening phase, 340 of the 384 accessible full-text articles were excluded based on the criteria. Ultimately, 44 articles that fully aligned with the objectives of the review were selected for final analysis. An additional 25 relevant articles, identified through manual searching, were also included. The final corpus comprised a total of 69 articles, encompassing quantitative, qualitative, and review studies. Figure 1 (PRISMA flow diagram) visually presents all these stages, ensuring transparency in the selection process.
Figure 1. PRISMA flowchart for the study selection process
From the review of 69 articles, three main domains were identified: socio-cultural and psychological factors; factors influencing family decision-making; and key factors in effective family communication. The first domain includes: religious beliefs, demographic factors, supports, cultural factors, policymaking, and psychological factors. The second domain includes family members, healthcare providers, and intermediaries. The third domain includes education and awareness, intra-family communication, communication between donor and recipient families, and communication between therapists and families. To better understand these components, they are presented in a diagram in Figure 2.
Figure 2. Components affecting the family institution in increasing organ donation
Discussion
Identifying touchpoints to capture audience attention is critical for increasing organ donation rates as well as for understanding the pathways through which potential donors become actual donors. Social marketing, with its dimensions and tools, plays a pivotal role in reaching these touchpoints. Raising awareness and highlighting the importance of organ donation, fostering effective communication, building trust, eliciting emotions, creating imagery, delivering accurate information, and ultimately inspiring action all require the identification and application of the components and subcomponents of social marketing dimensions.
In this study, we found that one of the most important target audiences in organ donation is the family. Families play a decisive role in the decision-making process, particularly when the deceased individual had not expressed a clear wish regarding organ donation. For this reason, numerous studies have examined practical strategies to influence families toward consenting to donation after a relative’s death. Previous studies have either addressed organ donation in general or covered only a limited aspect of the issue. The present study aimed to review existing literature to identify family touchpoints in the context of organ donation and incorporate them into a structured research framework.
The first major domain influencing family behavior toward organ donation consists of social, cultural, and psychological factors. Social factors refer to interpersonal structures and interactions, such as family networks, peer groups, and societal norms, that shape individuals’ behaviors and attitudes. Cultural factors encompass shared value systems, beliefs, and customs within a society or ethnic group that form collective and individual identity. Psychological factors involve mental processes such as perception, emotions, and motivation that guide decision-making and emotional responses. In organ donation, the family—as a key social unit—affects decision-making through emotional support, cultural beliefs about death and the body, and psychological attitudes toward loss. The aim of exploring this domain is to identify and optimize the factors with the greatest influence on changing attitudes, behaviors, and willingness among families to participate in organ donation.
The findings of this study indicate that family religious beliefs are one of the most determinant factors within the realm of social, cultural, and psychological components. This result aligns with international studies such as those by Lo et al. [13], El-Menyar et al. [14], Saxena et al. [15], and Stephan et al. [16], which have shown that religious beliefs can both hinder and encourage the organ donation process. However, some studies, such as Yousefi et al. [17], have demonstrated that in many societies, particularly in cultures where religious and spiritual values play a key role in life-and-death decisions, organ donation is considered unacceptable or even sinful, which is not consistent with the findings of the present study. This discrepancy may be attributed to differences in cultural context, the role of religious authorities in persuading families, or deficiencies in official information dissemination in the studied community.
Another component within this domain is demographic factors, referring to statistical characteristics of a population used to analyze social, economic, and cultural trends. These include variables such as age, gender, birth and death rates, migration, education level, marital status, employment, income, and geographic distribution. Various studies have highlighted the influence of demographic variables on family decision-making in organ donation, including Zhang et al. [18], Curtis et al. [19], and Opdam and Radford [20]. The present study not only underscores the role of demographic factors but also categorizes them into intervention-oriented themes for policymakers in the health sector.
Social support emerged as another influential component. Our findings align with those of Kerstis and Widarsson [21], who emphasized that social support—whether from government, healthcare systems, or community networks—can reduce the emotional burden on families and facilitate better-informed decision-making. Social support encompasses services, resources, and emotional, economic, and psychological assistance from governmental and non-governmental organizations, communities, and family networks, enabling families to better cope with challenges such as organ donation decisions.
Cultural beliefs are also critical in shaping families’ decisions. Cultural factors refer to the set of beliefs, values, norms, traditions, and attitudes prevalent in a society or social group that directly or indirectly influence individual attitudes and behaviors. In crisis situations, such as the death of a loved one, these factors become especially important. Siminoff et al. [22] demonstrated that tailoring educational and informational messages to cultural, ethnic, and linguistic backgrounds of target groups significantly increases family consent rates. Our findings confirm that ignoring cultural, linguistic, and ethnic sensitivities can result in resistance or refusal. Therefore, organizations responsible for organ donation in Iran should design culturally adapted communication packages in local languages and dialects that align with the values of each ethnic group.
Policy factors represent another key component. Coordinated policies, strategic planning, and the development of standard protocols for family support, consent acquisition, and legal frameworks have been highlighted in multiple studies. Park and Kim [23] found that the absence of clear, coordinated policies is a major barrier to increasing donation rates, recommending that countries focus on removing bureaucratic obstacles, streamlining legal procedures, and enhancing public education. Our findings similarly indicate that without legal support and a clearly defined donation pathway, families experience doubt and distrust.
Psychological factors also play a pivotal role in family decision-making. The acute emotional stress caused by a loved one’s death can impair families’ cognitive and emotional capacity for rational decision-making. Ahmadian et al. [24] found that anxiety, grief, and inner conflict can significantly hinder the willingness to donate, even when families are aware of the benefits, which is consistent with the present study and emphasize the need for psychological support during decision-making.
The second major domain concerns factors influencing the family decision-making process, including the roles of family members, healthcare providers, and mediators. The role of family members is central: Molina-Perez et al. [25] also emphasized that family participation is a cornerstone of the donation process. Our findings show that personal beliefs, trust in the healthcare system, and family cohesion are critical in shaping decisions.
Healthcare providers influence decision quality through clear and supportive communication. Sque et al. [26] reported that transparent and empathetic communication increases trust and consent rates. Similarly, our results indicate that pressure, ambiguity, or neglect from healthcare teams can lead to negative decisions. Physicians, nurses, and clinical staff must provide necessary information with clarity and sensitivity, while understanding family perspectives to support informed consent. Mediators—individuals who facilitate decision-making—can also shape family attitudes toward organ donation. Lalehgani et al. [10] found that skilled mediators increase the likelihood of positive decisions, while poor performance or inappropriate interventions may lead to refusal, consistent with our findings.
The third domain involves communication-related factors in family interactions. Effective communication strategies include targeted education and awareness, intra-family discussions, interactions between donor and recipient families, and communication between healthcare teams and
Identifying touchpoints to capture audience attention is critical for increasing organ donation rates as well as for understanding the pathways through which potential donors become actual donors. Social marketing, with its dimensions and tools, plays a pivotal role in reaching these touchpoints. Raising awareness and highlighting the importance of organ donation, fostering effective communication, building trust, eliciting emotions, creating imagery, delivering accurate information, and ultimately inspiring action all require the identification and application of the components and subcomponents of social marketing dimensions.
In this study, we found that one of the most important target audiences in organ donation is the family. Families play a decisive role in the decision-making process, particularly when the deceased individual had not expressed a clear wish regarding organ donation. For this reason, numerous studies have examined practical strategies to influence families toward consenting to donation after a relative’s death. Previous studies have either addressed organ donation in general or covered only a limited aspect of the issue. The present study aimed to review existing literature to identify family touchpoints in the context of organ donation and incorporate them into a structured research framework.
The first major domain influencing family behavior toward organ donation consists of social, cultural, and psychological factors. Social factors refer to interpersonal structures and interactions, such as family networks, peer groups, and societal norms, that shape individuals’ behaviors and attitudes. Cultural factors encompass shared value systems, beliefs, and customs within a society or ethnic group that form collective and individual identity. Psychological factors involve mental processes such as perception, emotions, and motivation that guide decision-making and emotional responses. In organ donation, the family—as a key social unit—affects decision-making through emotional support, cultural beliefs about death and the body, and psychological attitudes toward loss. The aim of exploring this domain is to identify and optimize the factors with the greatest influence on changing attitudes, behaviors, and willingness among families to participate in organ donation.
The findings of this study indicate that family religious beliefs are one of the most determinant factors within the realm of social, cultural, and psychological components. This result aligns with international studies such as those by Lo et al. [13], El-Menyar et al. [14], Saxena et al. [15], and Stephan et al. [16], which have shown that religious beliefs can both hinder and encourage the organ donation process. However, some studies, such as Yousefi et al. [17], have demonstrated that in many societies, particularly in cultures where religious and spiritual values play a key role in life-and-death decisions, organ donation is considered unacceptable or even sinful, which is not consistent with the findings of the present study. This discrepancy may be attributed to differences in cultural context, the role of religious authorities in persuading families, or deficiencies in official information dissemination in the studied community.
Another component within this domain is demographic factors, referring to statistical characteristics of a population used to analyze social, economic, and cultural trends. These include variables such as age, gender, birth and death rates, migration, education level, marital status, employment, income, and geographic distribution. Various studies have highlighted the influence of demographic variables on family decision-making in organ donation, including Zhang et al. [18], Curtis et al. [19], and Opdam and Radford [20]. The present study not only underscores the role of demographic factors but also categorizes them into intervention-oriented themes for policymakers in the health sector.
Social support emerged as another influential component. Our findings align with those of Kerstis and Widarsson [21], who emphasized that social support—whether from government, healthcare systems, or community networks—can reduce the emotional burden on families and facilitate better-informed decision-making. Social support encompasses services, resources, and emotional, economic, and psychological assistance from governmental and non-governmental organizations, communities, and family networks, enabling families to better cope with challenges such as organ donation decisions.
Cultural beliefs are also critical in shaping families’ decisions. Cultural factors refer to the set of beliefs, values, norms, traditions, and attitudes prevalent in a society or social group that directly or indirectly influence individual attitudes and behaviors. In crisis situations, such as the death of a loved one, these factors become especially important. Siminoff et al. [22] demonstrated that tailoring educational and informational messages to cultural, ethnic, and linguistic backgrounds of target groups significantly increases family consent rates. Our findings confirm that ignoring cultural, linguistic, and ethnic sensitivities can result in resistance or refusal. Therefore, organizations responsible for organ donation in Iran should design culturally adapted communication packages in local languages and dialects that align with the values of each ethnic group.
Policy factors represent another key component. Coordinated policies, strategic planning, and the development of standard protocols for family support, consent acquisition, and legal frameworks have been highlighted in multiple studies. Park and Kim [23] found that the absence of clear, coordinated policies is a major barrier to increasing donation rates, recommending that countries focus on removing bureaucratic obstacles, streamlining legal procedures, and enhancing public education. Our findings similarly indicate that without legal support and a clearly defined donation pathway, families experience doubt and distrust.
Psychological factors also play a pivotal role in family decision-making. The acute emotional stress caused by a loved one’s death can impair families’ cognitive and emotional capacity for rational decision-making. Ahmadian et al. [24] found that anxiety, grief, and inner conflict can significantly hinder the willingness to donate, even when families are aware of the benefits, which is consistent with the present study and emphasize the need for psychological support during decision-making.
The second major domain concerns factors influencing the family decision-making process, including the roles of family members, healthcare providers, and mediators. The role of family members is central: Molina-Perez et al. [25] also emphasized that family participation is a cornerstone of the donation process. Our findings show that personal beliefs, trust in the healthcare system, and family cohesion are critical in shaping decisions.
Healthcare providers influence decision quality through clear and supportive communication. Sque et al. [26] reported that transparent and empathetic communication increases trust and consent rates. Similarly, our results indicate that pressure, ambiguity, or neglect from healthcare teams can lead to negative decisions. Physicians, nurses, and clinical staff must provide necessary information with clarity and sensitivity, while understanding family perspectives to support informed consent. Mediators—individuals who facilitate decision-making—can also shape family attitudes toward organ donation. Lalehgani et al. [10] found that skilled mediators increase the likelihood of positive decisions, while poor performance or inappropriate interventions may lead to refusal, consistent with our findings.
The third domain involves communication-related factors in family interactions. Effective communication strategies include targeted education and awareness, intra-family discussions, interactions between donor and recipient families, and communication between healthcare teams and
families. Education and awareness are crucial in dispelling myths, addressing cultural and religious concerns, and presenting successful case experiences. Tools such as workshops, media campaigns, specialized counseling, and mass media can improve knowledge and attitudes. Siminoff et al. [27] found that online educational programs enhance family engagement and public acceptance, supporting our thematic findings.
Intra-family discussions have a decisive impact, as highlighted by Wang [28], who showed that addressing organ donation within the family before a crisis improves readiness and facilitates informed consent. Our findings similarly identify such discussions as a key factor, as they clarify values and preferences, particularly when the deceased’s wishes are known. Contact between donor and recipient families emerged as another influential factor. This connection can reduce grief, provide meaning, and strengthen satisfaction with the donation decision. Petrini [29] emphasized that when facilitated under appropriate legal and psychological frameworks, such contact enhances the donation experience. Our findings confirm that many families gain comfort and meaning from perceiving the life-saving impact of their decision.
Communication between healthcare providers and bereaved families is critical. Curtis et al. [19] found that the presence of trained professionals in sensitive conversations significantly improves consent rates. Our results align, emphasizing the importance of trained transplant coordinators, timely discussions regarding brain death, and adherence to supportive communication protocols such as the Comfort model [30], which advocates for empathetic language and appropriate timing.
Limitations
One of the limitations of the present study was the lack of access to the full text of some articles. Another limitation was the use of sources published between 2020 and 2024, could also be considered a major weakness of the present study.
Conclusion
This study identified key components and touchpoints influencing family decisions on organ donation within a social marketing framework. Three domains emerged: (1) social, cultural, and psychological factors; (2) factors influencing family decision-making; and (3) factors in effective family communication. Applying social marketing principles that focus on family needs and values can enhance awareness, trust, and consent rates. Policymakers should implement long-term, culturally tailored strategies that combine family empowerment, empathy-driven communication, immediate psychological support, collaboration with religious and civic leaders, and promotion of pre-crisis family discussions. Leveraging behavioral models, big data, and longitudinal monitoring can strengthen public trust and expand acceptance of organ donation.
Online supplement
Search strategy
Characteristics of included studies
Declarations
Ethical considerations: Not Applicable.
Funding: This research was conducted without any financial support.
Conflicts of interests: The authors declare that there is no conflict of interest.
Authors’ contribution: ME: Conceptualization, study design, data curation, methodology, software, validation, data analysis, resources, writing– original draft, writing– review & editing, visualization; HBKH: Conceptualization, study design, methodology, validation, writing– review & editing, supervision, final approval; HGH: Conceptualization, study design, methodology, validation, final approval; ASH: Methodology, validation, final approval.
Consent for publication: Not applicable.
Data availability: Access to the data is available through the corresponding author upon reasonable request.
AI deceleration: The authors used ChatGPT artificial intelligence for editing the English section of this article. All AI-edited content was reviewed and approved by the authors.
Acknowledgements: The authors would like to acknowledge Dr. Fatemeh Sadeghi Ghiyasi from the Research Development and Coordination Center of the University of Medical Sciences, Mr. Hossein Saeedi from the Central Library of the University of Medical Sciences, and the esteemed faculty members of Islamic Azad University for their valuable consultation on the scoping review, thematic analysis, and overall research process.
Intra-family discussions have a decisive impact, as highlighted by Wang [28], who showed that addressing organ donation within the family before a crisis improves readiness and facilitates informed consent. Our findings similarly identify such discussions as a key factor, as they clarify values and preferences, particularly when the deceased’s wishes are known. Contact between donor and recipient families emerged as another influential factor. This connection can reduce grief, provide meaning, and strengthen satisfaction with the donation decision. Petrini [29] emphasized that when facilitated under appropriate legal and psychological frameworks, such contact enhances the donation experience. Our findings confirm that many families gain comfort and meaning from perceiving the life-saving impact of their decision.
Communication between healthcare providers and bereaved families is critical. Curtis et al. [19] found that the presence of trained professionals in sensitive conversations significantly improves consent rates. Our results align, emphasizing the importance of trained transplant coordinators, timely discussions regarding brain death, and adherence to supportive communication protocols such as the Comfort model [30], which advocates for empathetic language and appropriate timing.
Limitations
One of the limitations of the present study was the lack of access to the full text of some articles. Another limitation was the use of sources published between 2020 and 2024, could also be considered a major weakness of the present study.
Conclusion
This study identified key components and touchpoints influencing family decisions on organ donation within a social marketing framework. Three domains emerged: (1) social, cultural, and psychological factors; (2) factors influencing family decision-making; and (3) factors in effective family communication. Applying social marketing principles that focus on family needs and values can enhance awareness, trust, and consent rates. Policymakers should implement long-term, culturally tailored strategies that combine family empowerment, empathy-driven communication, immediate psychological support, collaboration with religious and civic leaders, and promotion of pre-crisis family discussions. Leveraging behavioral models, big data, and longitudinal monitoring can strengthen public trust and expand acceptance of organ donation.
Online supplement
Search strategy
Characteristics of included studies
Declarations
Ethical considerations: Not Applicable.
Funding: This research was conducted without any financial support.
Conflicts of interests: The authors declare that there is no conflict of interest.
Authors’ contribution: ME: Conceptualization, study design, data curation, methodology, software, validation, data analysis, resources, writing– original draft, writing– review & editing, visualization; HBKH: Conceptualization, study design, methodology, validation, writing– review & editing, supervision, final approval; HGH: Conceptualization, study design, methodology, validation, final approval; ASH: Methodology, validation, final approval.
Consent for publication: Not applicable.
Data availability: Access to the data is available through the corresponding author upon reasonable request.
AI deceleration: The authors used ChatGPT artificial intelligence for editing the English section of this article. All AI-edited content was reviewed and approved by the authors.
Acknowledgements: The authors would like to acknowledge Dr. Fatemeh Sadeghi Ghiyasi from the Research Development and Coordination Center of the University of Medical Sciences, Mr. Hossein Saeedi from the Central Library of the University of Medical Sciences, and the esteemed faculty members of Islamic Azad University for their valuable consultation on the scoping review, thematic analysis, and overall research process.
Type of Study: Research |
Subject:
Health Services Management
Received: 2025/04/12 | Accepted: 2025/09/3 | Published: 2025/09/21
Received: 2025/04/12 | Accepted: 2025/09/3 | Published: 2025/09/21
Supplement [PDF 451 KB] (71 Download)
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