Introduction: The Global Observatory on Donation and Transplantation (GODT) reported that <10% of the global needs are fulfilled. Our goal was to assess the knowledge and comfort gaps in the acceptance of deceased donors (DD).
Methods: We performed a survey from May 2022 to March 2023, including Tx physicians and surgeons. Responders were divided into five groups as per the mean DD rate per million population (PMP) from years 2016-2021 (2020 was excluded because of the COVID-19 pandemic): 1) No DD reported, or no data provided to GODT; 2) <10; 3) 10-19.9; 4) 20-29.9; 5) 30 DD PMP. We used ANOVA (linear trend) to compare the median gap (desired minus current) for knowledge or comfort. As an example, I understand the benefits of accepting organs from high social risk donors, but I feel uncomfortable accepting those organs. 
Results: We found significant gaps in both knowledge and comfort regarding the acceptance of DD, as follows: Donors with a history of high-risk behaviour (Figure 1), positive blood cultures and appropriate treatment (Figure 2), as well as in donors with isolated anti-HBc Ab+.
Significant gaps only in knowledge were the following: excessive cigarette smoking, excessive alcohol use, positive COVID-19 PCR; HCV+, HIV+, positive serology for Chagas, multidrug-resistant bacterial infection, primary brain malignancies, pre-Tx HLA testing for immunological risk stratification, crossmatch testing methods, role of cfDNA in non-invasive diagnosis of rejection, surveillance of DSA post-Tx.
No differences in knowledge and comfort were observed in the following: HBs Ag+, <5-year history of other malignancies, impact of non-HLA Ab on transplant outcomes, and unacceptable donor HLA antigens.
Significant differences across countries were seen mainly in those with lower DD rates.
Conclusion: This global survey suggests that there are knowledge and comfort gaps related to the acceptance of DD. It suggests that educational activities should address the gaps with the goal of increasing the access to organ Tx globally.