Willingness to Bone Allograft Donation and Transplantation in Sub-Saharan Africa: A Multi-Country Cross- Sectional Study

Background. Bone is the second most frequently transplanted human tissue worldwide, with 2.2 million grafts performed annually. In sub-Saharan Africa, donor and recipient consent remains uncertain due to diverse cultural, religious, and socioeconomic contexts. This study assessed public attitudes toward bone allograft donation and transplantation in Cameroon, Côte d’Ivoire, and the Democratic Republic of Congo to support the planning and implementation of bone banks. Methods. A multicountry cross-sectional survey was conducted between January and December 2024. Six hundred adults (200 per country) were recruited through stratified convenience sampling in urban and rural settings. After informed consent, participants completed an interviewer-administered questionnaire capturing sociodemographic data, willingness to donate and receive bone allografts, and reasons for refusal. Descriptive statistics, univariate and multivariate logistic regression identified predictors of willingness. Results. The cohort (mean age 36.2 years) reported a willingness to donate of 72.5% and transplantation acceptance of 72.8%. Refusal for donation was mainly linked to philosophical or spiritual beliefs, fear of trafficking, and remuneration request. Multivariate analysis showed that country of residence, religion, and occupation independently predicted donation, while acceptance was influenced by country and religion. Conclusion. Willingness to donate and receive bone allografts in sub-Saharan Africa is relatively high and comparable to high-income regions, though heterogeneity exists between countries. Key barriers include religious convictions, mistrust of health systems, and socioeconomic vulnerabilities. Establishing bone banks will require culturally sensitive education, transparent governance, and community engagement to transform willingness into effective donation practices.