Sociodemographic predictors of public attitudes toward deceased organ donation and organ trade in Kazakhstan.

Public attitudes toward deceased organ donation emerge at the intersection of cultural norms, moral beliefs, media narratives, and trust in health institutions. In post-Soviet contexts such as Kazakhstan, low levels of health literacy and persistent rumors surrounding a "black market" in organs continue to function as barriers to donation and as sources of skepticism toward medical institutions. Despite recent legislative reforms and public-awareness initiatives, sociological evidence explaining how demographic, cognitive, and institutional factors shape these perceptions remains limited. This study examines how age and education influence public attitudes toward deceased organ donation and beliefs about illegal organ trade in Kazakhstan, while also exploring behavioral readiness for formal donor registration and the hierarchical interaction of cognitive and institutional determinants of donation attitudes. Between February 2024 and April 2025, a representative survey of 569 adult residents of Almaty and the Almaty region was conducted using a quota-based sample stratified by age, gender, and education level. Descriptive statistics and Fisher's Exact Test were used to examine demographic differences in awareness and trafficking-related beliefs, while multivariable logistic regression and a decision-tree classifier were applied to evaluate behavioral readiness for donor registration and hierarchical relationships among cognitive, institutional, and attitudinal predictors. Analyses were performed using IBM SPSS v.28 and Python (v.3.10). Education level emerged as the strongest and most consistent predictor of informed and critical attitudes toward deceased organ donation. Respondents with higher education were more likely to demonstrate awareness of legal and medical donation criteria and less likely to endorse trafficking-related misconceptions. Age primarily differentiated preferred communication channels, with younger respondents relying more frequently on digital media and older groups preferring television-based information sources, while no statistically significant association was observed between age and belief in organ trafficking. The adjusted regression analysis additionally indicated that place of residence was the strongest independent predictor of willingness to formally register donor consent through the national e.gov system. The decision tree analysis identified brain-death awareness and institutional trust as the central hierarchical determinants shaping support for deceased organ donation. The findings suggest that public attitudes toward organ donation in Kazakhstan are shaped not only by demographic characteristics but also by broader institutional and informational environments. Strengthening health literacy, improving institutional transparency, and developing communication strategies adapted to different social groups may increase trust, reduce misinformation, and enhance public readiness to support deceased organ donation and formal donor registration.