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Informing national policy: Healthcare workers’ readiness for a deceased donor kidney transplant program in Brunei Darussalam
Nor Islya Emma Othman, Chiao Yuen Lim, Lubna Razak, Musuriani Yusuf, Dalinatul Ahmed, Fazean Idris, Nayan Joshi, Muhammad Abdul Mabood Khalil, Minh Cuong Duong, Jackson Tan
Nor Islya Emma Othman, Chiao Yuen Lim, Musuriani Yusuf, Dalinatul Ahmed, Jackson Tan, Department of Renal Services, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam
Lubna Razak, Department of Policy Planning, Ministry of Health, Bandar Seri Begawan BB3910, Brunei Darussalam
Fazean Idris, UBD PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan BE1410, Brunei Darussalam
Nayan Joshi, Department of Ophthalmology, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam
Muhammad Abdul Mabood Khalil, Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital, Jeddah 23311, Makkah Al Mukarramah, Saudi Arabia
Minh Cuong Duong, School of Population Health, University of New South Wales, Sydney 2033, New South Wales, Australia
Author contributions: Othman NIE, Lim CY, Razak L, Yusuf M, Ahmed D, Idris F, Joshi N, Khalil MAM, Duong MC, and Tan J conceptualized the study; Authors Othman NIE, Lim CY, Razak L, Yusuf M, Ahmed D, Idris F, and Joshi N were involved in data collection; Tan J performed the statistical analysis and wrote the initial manuscript. All authors confirmed the final edition.
AI contribution statement: ChatGPT was used for language polishing and to improve readability.
Institutional review board statement: This study was approved by the Medical and Health Research Ethic Committee of Raja Isteri Pengiran Anak Saleha Hospital (Approval No. MHREC/MOH/2025/28).
Informed consent statement: Informed consent was obtained from all participants prior to enrolment in the study. Participants were provided with written information outlining the study purpose, procedures, potential risks, and their rights, including the voluntary nature of participation and the ability to withdraw at any time without penalty. All responses were anonymized to ensure confidentiality.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All data pertaining to this research can be shared through the corresponding author, if required.
Corresponding author: Jackson Tan, Department of Renal Services, Raja Isteri Pengiran Anak Saleha Hospital, Jalan Putera Al-Muhtadee Billah, Bandar Seri Begawan BA1712, Brunei Darussalam.
drjacksontan74@gmail.com
Received: December 11, 2025
Revised: February 10, 2026
Accepted: March 13, 2026
Published online: June 18, 2026
Processing time: 170 Days and 0.9 Hours
BACKGROUND
Brunei Darussalam currently lacks a deceased donor kidney transplant (DDKT) program, and its establishment in a small population poses challenges related to limited expertise and community misconceptions. Healthcare workers (HCWs), as the operational backbone of any transplant service, are central to translating policy into practice and guiding patient understanding. Assessing their perceptions is essential for gauging system readiness and informing strategies for future program development.
AIM
To explore HCWs’ views on initiating a DDKT program, with specific focus on knowledge of kidney disease and attitudes toward deceased organ donation, opt-in donor card policy and transplant commercialization.
METHODS
This was a questionnaire-based knowledge, attitude and practice study conducted at the main tertiary hospital in Brunei Darussalam. Statistical analyses included bivariate tests for categorical variables and multivariable logistic regression to identify factors associated with supportive or non-supportive attitudes towards DDKT.
RESULTS
A total of 370 HCWs participated in the study, with a female predominance (76%), comprising 58 doctors, 271 nurses, and 41 allied health professionals. Overall, 61% of respondents demonstrated high knowledge, while 39% had low knowledge. Regarding attitudes toward DDKT, 44% agreed, 12% disagreed, and 45% remained neutral. An opt-in donor card system was favored by 54%, while 35% were neutral and 11% disagreed. Attitudes towards transplant commercialization showed little variation, with 21% expressing acceptance, 45% neutrality, and 33% disagreement. Islamic religion, Malay ethnicity, nursing profession, lower knowledge level, female sex, and unawareness of fatwa were significantly associated with disagreement towards both DDKT and the donor card system (all P < 0.05). In multivariable logistic regression analysis, profession [adjusted odds ratio (aOR) = 4.54], religion (aOR = 7.34), education level (aOR = 4.11) and knowledge status (aOR = 1.88) remained independently associated with disapproval of DDKT.
CONCLUSION
Among HCWs in Brunei Darussalam, support for a DDKT program outweighs opposition, although a sizeable proportion remain undecided. Notably, some view commercialized transplantation as a potential means to address donor shortages, signaling ethical and policy concerns. These findings underscore the need to address knowledge gaps, enhance educational exposure, and clarify contextual issues to inform the development of a national DDKT program.
Core Tip: This study explored the views of 370 healthcare workers in Brunei Darussalam on establishing a deceased donor kidney transplant (DDKT) program. Most were female (76%) and included doctors, nurses and allied health staff. Overall, 61% showed high knowledge. Support for DDKT (44%) exceeded opposition (12%), though 45% were undecided. An opt-in donor card system was favored by 54%, while attitudes toward transplant commercialization were mixed, with 21% accepting it. Disapproval of DDKT and donor cards was associated with Islamic religion, Malay ethnicity, nursing profession, lower knowledge, female sex, and unawareness of fatwa. Multivariable analysis confirmed profession, religion, education and knowledge as independent predictors of disapproval.
