Abstract
Background
The placenta is a rich source of stem cells that can be used in scientific research and therapeutic applications. The aim of the current study was to understand the perspectives of Jordanian women on placenta donation for research purposes.
Methods
The study questionnaire was developed using Google Forms and distributed across social media platforms. A total of 923 women participated in the study.
Results
About 64.0% of women were unaware that placenta could be donated for research. Only 27.0% expressed a positive attitude toward donation, while approximately 23.2% considered placenta donation ethically acceptable. Factors associated with the management of placenta after pregnancy included the woman’s age, education level, living in a city, and pregnancy status (p < 0.05). Reasons associated with the decline in placenta donation for research included misuse of the placenta (65.6%), potential commercial use (86.5%), desire to keep it in a cell bank (52.2%), and data privacy issues (70.0%).
Conclusion
Awareness of placenta donation for medical research was found to be low. A small percentage of women supported the placenta use in research. The study recommends interventions and educational programs to enhance women’s awareness of placenta donation in scientific research, which can be implemented by health authorities. Moreover, fostering partnerships between the public and scientists is essential to encouraging innovation and progress in stem cell research.
Keywords: Placenta, Pregnant women, Ethics, Donation, Research
Introduction
The placenta plays a vital role during pregnancy by protecting the fetus and regulating the transport of nutrients, growth factors, and gases between the maternal and fetal circulations [1]. The placenta is a rich source of stem cells, including epithelial and mesenchymal stem cells, that can be utilized in preclinical and translational research as in vitro models and in medicine for the treatment of diseases [2, 3] These cells have demonstrated multi-lineage differentiation potential in vitro, revealing a promising therapeutic potential for metabolic, blood, and immune disorders [3–5]. Furthermore, placentas are rich sources of trophoblast organoids, which are vital tools for exploring previously obscure processes that occur within the uterus, and hence determining the health of offspring [6].
Placental stem cells have been described as advantageous because they carry fewer ethical concerns, are more accessible, and are less immunogenic than many adult sources [7]. This has shifted the practice of discarding placenta following the delivery of the baby towards preserving it for potential use in medicine/research fields [8, 9]. Therefore, many studies have called for more research on the proper management of human placenta after delivery [8, 9].
In Jordan and many countries in the Middle East and North Africa (MENA) region, umbilical cord blood donation has received greater attention than placenta donation. This interest stems from feasibility studies and surveys that demonstrate physician as well as public interest in cord blood banking [10, 11]. In addition, literature on women’s view on placental tissue donation is scarce, with some studies conducted in Brazil and Nigeria, despite global evidence highlighting its rich stem cell potential [12–14].
However, Jordan was a pioneer in passing legislation in 2014, Jordan Stem Cells Status, to regulate the utilization of stem cells both for medical and research purposes. According to this legislation, the use of stem cells, including those derived from the umbilical cord or placenta, in research is restricted to specialized governmental centers or educational institutions, which follow strict instructions [15]. In practice, the implementation of this legislation in Jordan (as in many countries in the region) has so far focused on cord blood banks, while placental tissue collection and preservation programs remain very limited. On the other hand, many obstetricians in Jordan viewed tissue donation as an ethical as well as religious controversy [10]. Nevertheless, protecting privacy and confidentiality, ownership, commercial use, and obtaining informed consent are fundamental ethical principles that should guide tissue donation [16].
Understanding the public’s views on placental donation for research and disease treatment may advance the utilization of the placenta for the advancement of science and human health. Additionally, a significant gap remains in the use of placental stem cells when translating public needs into clinical standards [17]. Moreover, the ethical aspects and components associated with the willingness of donating placental tissues for research and therapeutic use are still not well studied [18]. Therefore, this study aimed to understand Jordanian women’s awareness and attitudes towards placenta donation for research and treatment of human diseases.
Methods
The study participants
The study employs a quantitative, cross-sectional design to assess the awareness and attitudes of Jordanian women towards placenta donation for research purposes. The study procedure was approved by the Institutional Review Board of the Jordan University of Science and Technology, Jordan (Ref No 2024/377). A convenient sampling approach was adopted. A total of 923 women of reproductive age volunteered in the study from most areas of Jordan.
Google Forms platform was used to prepare the study questionnaire. Anonymous data were collected after informed consent was obtained from each woman. Participants were recruited using common social media platforms, including WhatsApp and Facebook. The sample size was determined using G*Power software, with a moderate effect size and a power of 95%. The minimum required number of subjects was 780.
Study instrument
This questionnaire was designed based on prior research that investigated people’s attitudes regarding tissue donation for research [19–21]. The study instrument included several parts. The first part included questions about demographics, including age (stratified at approximately 10-year intervals), education (basic education, secondary education, diploma, bachelor’s degree, postgraduate degree), having a degree in biomedical sciences, place of living (city vs. village), pregnancy status, and history of participation in previous studies. The second part includes questions about the participants’ awareness and attitudes toward placenta donation for scientific research. This was deduced by several questions that include: (1) “Prior to participating in this survey, were you aware of the possibility of donating a placenta for scientific research purposes?” the given choices were “Yes” or “No.” (2) “What do you intend to do with the placenta after giving birth?” The given choices were “to dispose of it”, “to store it in the cell bank,” or “to donate to medical research.” (3) “How well are you aware of the benefits of using placenta in scientific research? The given choices were: “I have a comprehensive knowledge of the benefits”, “I have a good knowledge of the benefits”, “I have a moderate knowledge of the benefits”, “I have a little knowledge of the benefits”, and “I know no knowledge about the benefits”. (4) “If you donate the placenta to medical research, what do you think about its ownership?” The given choices were: “I always own it”, “It is owned by research”, and “I am not sure”. The third part of the questionnaire asked those who were aware of the possibility of donating the placenta: “If you were aware of the possibility of donating the placenta for medical research, what was the source of your information? The given choices were: “Healthcare providers”, “Social media”, “Web browsing sites (Google and others)”, “Family and friends”, “TV and newspapers”, and “Others (please mention.”. The questionnaire also asked about women’s opinions regarding the various applications of stem cells derived from placental tissue. Women were presented with five items with a choice of “Yes” or “No.” The items were neurological injuries research, chronic diseases research, regenerative medicine research, genetic research, vaccinations research, and environmental research. The questionnaire was revised by an expert in the field, and a pilot test was conducted on 15 women to ensure the wording was appropriate. Test-retest reliability and internal consistency were assessed. Cronbach’s values for both tests were >0.75 overall and for every item of the survey. Data was collected from August 2024 to September 2024.
Statistical analysis
Data was analyzed using SPSS statistical software version 27. Socio-demographic characteristics were presented as frequencies and percentages. The chi-square (χ2) test was used to assess the association between the demographics of women and their awareness and attitude regarding placenta donation for medical research. In addition, Multinomial regression analysis was used to analyze factors associated with willingness to donate the placenta for research. The 95% confidence intervals (CIs) were computed. The statistical significance level was detected by a p-value < 0.05.
Results
The study included 923 women. The demographics of women are presented in Table 1. The majority of participants hold a bachelor’s degree (52.3%), are from a non-medical field (82.6%), reside in a city (78.0%), and have never volunteered for research (75.3%).
Table 1.
Characteristics of the women responding to a survey about placenta donation
| Item | Sub-item | N = 923 (%) |
|---|---|---|
| Age groups | 18–30 | 445 (48.2) |
| 31–40 | 366(39.7) | |
| 41–50 | 112 (12.1) | |
| Education | School education | 216 (23.4) |
| Diploma | 127(13.8) | |
| Bachelor’s degree | 483(52.3) | |
| Postgraduate degree | 97(10.5) | |
| Degree in biomedicine | Yes | 161(17.4) |
| No | 762(82.6) | |
| Place of living | City | 720(78.0) |
| Village | 203(22.0) | |
| Pregnancy status | I am currently pregnant | 372 (40.3) |
| I was pregnant before | 391(42.4) | |
| I am in the planning stage of pregnancy | 160(17.3) | |
| Prior research participation | Yes | 228 (24.7) |
| No | 695(75.3) |
Slightly less than two-thirds of the participants were unaware of the possibility of donating their placenta for scientific research purposes, and less than half were unaware of the benefits of using placentas in scientific research. Moreover, about one-third favored storing stem cells in a cell bank for potential future family use, and a similar percentage showed interest in disposing of the placenta as medical waste. Meanwhile, about a quarter of the participants preferred to donate their placenta to medical research. Lastly, women were asked about the ownership of the placenta when donating it to medical research; fewer than half thought it was owned by researchers, while almost the same percentage of women were unsure. On the other hand, the rest (8.9%) thought that the placenta, after donation to medical research, is always owned by the donor woman (Table 2).
Table 2.
Awareness and attitudes of women toward placenta donation
| Item | Sub-item | N = 923 (%) |
|---|---|---|
| Awareness of the possibility of placenta donation | Yes | 332 (36.0) |
| No | 591 (64.0) | |
| Women’s attitude toward placenta management after birth | Prefer to dispose it as medical waste | 356 (38.5) |
| Prefer to store its stem cells in a cell bank | 318 (34.5) | |
| Prefer to donate to medical research | 249 (27.0) | |
| Awareness of the benefits of using the placenta in scientific research | Comprehensive knowledge of the benefits | 27 (2.9) |
| Good knowledge of the benefits | 78 (8.5) | |
| Intermediate knowledge of the benefits | 136 (14.7) | |
| Little knowledge of the benefits | 278 (30.1) | |
| No knowledge about the benefits | 404 (43.8) | |
| Ownership of the placenta after donation to scientific research | I always own it | 82 (8.9%) |
| It is owned by researcher | 438 (47.5) | |
| I am not sure | 403 (43.7) |
The sources of information by women who reported awareness of placental donations for research were from highest to lowest: social media, internet, healthcare providers, family members/friends, TV channels/newspapers, and others (see Table 3 for exact percentages).
Table 3.
Source of knowledge about using placentas for research
| Sub-item | N = 326(%) |
|---|---|
| Healthcare providers | 68 (20.9%) |
| Social media | 125 (38.3%) |
| Web browsing sites (Google and others) | 85 (26.1%) |
| Family and friends | 17(5.2%) |
| TV and newsletters | 15(4.6%) |
| Others | 16 (4.9%) |
Table 4 presents a cross-tabulation of demographic factors and awareness of placenta donation for research purposes. Significant associations were observed between awareness, having a degree in biomedicine, living in a city, and previous research participation (P < 0.001).
Table 4.
Cross-tabulation of participants’ demographics with awareness about placenta donation to research
| Item | Sub-item | Yes | No | P-value |
|---|---|---|---|---|
| Age groups | 18–30 | 176 (39.6) | 269 (60.4) | 0.068 |
| 31–40 | 116 (31.7) | 250 (68.3) | ||
| 41–50 | 40 (35.7) | 72 (64.3) | ||
| Education | School education | 69 (31.9) | 147 (68.1) | 0.091 |
| Diploma | 47 (37.0) | 80 (63.0) | ||
| Bachelor’s degree | 189 (39.1) | 294 (60.9) | ||
| Postgraduate degree | 27 (27.8) | 70 (72.2) | ||
| Degree in biomedicine | Yes | 77 (47.8) | 84 (52.2) | < 0.001 |
| No | 255 (33.5) | 507 (66.5) | ||
| Place of living | City | 276 (38.3) | 444(61.7) | 0.005 |
| Village | 56 (27.6) | 147(72.4) | ||
| Pregnancy status | I am currently pregnant | 131 (35.2) | 241 (64.8) | 0.923 |
| I was pregnant before | 143 (36.6) | 248 (63.4) | ||
|
In the planning stage of pregnancy |
58 (36.3) | 102 (63.7) | ||
| Prior research participation | Yes | 104 (45.6) | 124 (54.4) | < 0.001 |
| No | 228 (32.8) | 467 (67.2) |
Table 5 shows a cross-tabulation of the participants’ demographics with their intention to manage the placenta after delivery. Age group, education, degree in biomedicine, place of living, and pregnancy status were significantly associated with women’s attitudes toward managing the placenta after giving birth. Elderly women aged 41 and above were more likely to donate their placenta for research than those aged under 40 (P < 0.01). Women with bachelor’s degrees and higher education were more likely to store placental stem cells for future family use than women with diplomas and secondary education, who prefer to dispose of them as medical waste. In contrast, those with secondary education are more likely to donate their placenta for research (P < 0.01). Similarly, women with a degree in biomedicine may influence women’s preferences, with those holding such degrees being less likely to donate than those without a degree (P < 0.008). Furthermore, individuals living in cities have a higher intention to donate their placenta compared to those residing in provinces, and those with children compared to those currently pregnant (P < 0.01, Table 5).
Table 5.
Cross-tabulation of participants’ demographics with their intention to manage the placenta after delivery (n = 923)
| Item | Sub-item | Dispose of it as medical waste: N(%) | Store its stem cells in the cell bank: N(%) | Agree to donate: N(%) | P value |
|---|---|---|---|---|---|
| Age groups | 18–30 | 176 (39.6) | 162 (36.4) | 107 (24.0) | < 0.001 |
| 31–40 | 153 (41.8) | 122 (33.3) | 91(24.9) | ||
| 41–50 | 27 (24.1) | 34 (30.4) | 51 (45.5) | ||
| Education | School education | 96 (44.4) | 49 (22.7) | 71 (32.9) | < 0.001 |
| Diploma | 51 (40.2) | 37 (29.1) | 39 (30.7) | ||
| Bachelor’s degree | 175 (36.2) | 193 (40.0) | 115 (23.8) | ||
| Higher education | 34 (35.1) | 39 (40.2) | 24 (24.7) | ||
| Degree in biomedicine | Yes | 56 (34.8) | 72 (44.7) | 33 (20.5) | 0.008 |
| No | 300 (39.4) | 246 (32.3) | 216 (28.3) | ||
| Place of living | City | 260 (36.1) | 261 (36.3) | 199 (27.6) | 0.013 |
| Village | 96 (47.3) | 57 (28.1) | 50 (24.6) | ||
| Pregnancy status | I am currently pregnant | 175 (47.0) | 115 (30.9) | 82 (22.0) | < 0.001 |
| I was pregnant before | 138 (35.3) | 129 (33) | 124 (31.7) | ||
|
In the planning stage of pregnancy |
43 (26.9) | 74 (46.3) | 43 (26.9) | ||
| Prior research participation | Yes | 84 (36.8) | 91 (39.9) | 53 (23.2) | 0.110 |
| No | 272 (39.1) | 227 (32.7) | 196 (28.2) |
Multinomial regression analysis (Table 6) of socio-demographic variables (independent variables) and placenta management (dependent variable) showed that age and pregnancy status were significantly associated with women’s willingness to donate their placentas for the research. Women under the age of 40 were less likely to donate their placenta for research (age category/OR [95% CI] = 18–30 years/0.392 [0.215–0.714]; 31–40 years/0.349 [0.197–0.617], P < 0.01). In addition, pregnant women were less likely to donate their placenta for research than non-pregnant ones (currently pregnant, OR [95% CI] = 0.472 [0.285–0.783], P < 0.01). Moreover, education, place of living, and pregnancy status were significantly associated with women’s willingness to store placental stem cells in a biobank for future use. Women with a school education (OR [95% CI] = 0.484 [0.264–0.888], P < 0.05), currently pregnant women (OR [95% CI] = 0.383 [0.243–0.604], P < 0.001), and previously pregnant women (OR [95% CI] = 0.526 [0.329–0.839], P < 0.001) were less likely to store placental stem cells for future use (Table 6). On the other hand, women residing in cities were more likely to want to store placental stem cells for future use (OR [95% CI] = 1.673 [1.144–2.446].
Table 6.
Multinomial regression analysis shows the association between socio-demographic variables (independent variables) and placenta management (dependent variable, the categorical reference being disposing of placenta as medical waste)
| Dependent variable: donating placenta for scientific research | |||||||
| Variable | Sub-item | B | Std. Error | Wald | df | P - value | Odd ratio (95% confidence interval) |
| Age groups | 41–50 | - | - | - | 0 | - | Reference group |
| 18–30 | -0.937 | 0.306 | 9.370 | 1 | 0.002 | 0.392 (0.215–0.714) | |
| 31–40 | -1.053 | 0.291 | 13.085 | 1 | < 0.001 | 0.349 (0.197–0.617) | |
| Education | Higher education | - | - | - | 0 | - | Reference group |
| School education | 0.243 | 0.329 | 0.548 | 1 | 0.459 | 1.276 (0.67–2.43) | |
| Diploma | 0.208 | 0.352 | 0.349 | 1 | 0.555 | 1.231 (0.618–2.453) | |
| Bachelor’s degree | 0.102 | 0.304 | 0.112 | 1 | 0.738 | 1.107 (0.610–2.008) | |
| Degree in biomedicine | Yes | - | - | - | 0 | - | Reference group |
| No | 0.145 | 0.256 | 0.321 | 1 | 0.571 | 1.156 (0.700-1.911) | |
| Place of living | Village | - | - | - | 0 | - | Reference group |
| City | 0.359 | 0.203 | 3.119 | 1 | 0.077 | 1.431 (0.961–2.131) | |
| Pregnancy status | Planning stage | - | - | - | 0 | - | Reference group |
| Currently pregnant | -0.75 | 0.258 | 8.453 | 1 | 0.004 | 0.472 (0.285–0.783) | |
| Was pregnant | -0.358 | 0.261 | 1.887 | 1 | 0.169 | 0.699 (0.419–1.165) | |
| Prior research participation | Yes | - | - | - | 0 | - | Reference group |
| No | 0.055 | 0.214 | 0.067 | 1 | 0.796 | 1.057 (0.695–1.608) | |
| Dependent variable: storing placental stem cells in a biobank for future use | |||||||
| Item | Sub-item | B | Std. Error | Wald | df | P- value | Odd ratio (95% confidence interval) |
| Age groups | 41–50 | - | - | - | 0 | - | Reference group |
| 18–30 | -0.115 | 0.315 | 0.133 | 1 | 0.715 | 0.891 (0.481–1.654) | |
| 31–40 | -0.437 | 0.304 | 2.067 | 1 | 0.151 | 0.646 (0.356–1.172) | |
| Education | Higher education | - | - | - | 0 | - | Reference group |
| School education | -0.725 | 0.309 | 5.494 | 1 | 0.019 | 0.484 (0.264–0.888) | |
| Diploma | -0.436 | 0.326 | 1.783 | 1 | 0.182 | 0.647 (0.341–1.226) | |
| Bachelor’s degree | -0.013 | 0.266 | 0.002 | 1 | 0.962 | 0.987 (0.587–1.662) | |
| Degree in biomedicine | Yes | - | - | - | 0 | - | Reference group |
| No | -0.237 | 0.217 | 1.189 | 1 | 0.276 | 0.789 (0.515–1.208) | |
| Place of living | Village | - | - | - | 0 | - | Reference group |
| City | 0.514 | 0.194 | 7.042 | 1 | 0.008 | 1.673 (1.144–2.446) | |
| Pregnancy status | Planning stage | - | - | - | 0 | - | Reference group |
| Currently pregnant | -0.959 | 0.232 | 17.039 | 1 | 0.000 | 0.383 (0.243–0.604) | |
| Was pregnant | -0.643 | 0.239 | 7.262 | 1 | 0.007 | 0.526 (0.329–0.839) | |
| Prior research participation | Yes | - | - | - | 0 | - | Reference group |
| No | -0.098 | 0.192 | 0.261 | 1 | 0.609 | 0.907 (0.622–1.321) | |
Regarding concerns about placental donation for research, the results revealed a complex ethical perspective, with nearly a quarter of women (23.2%) believing it is ethically acceptable, while (9.8%) consider it unethical. The largest group (47.0%) stated that their position depended on the conditions applied, and approximately 19.6% did not express a definite opinion on the issue. On the other hand, women were asked about the importance of keeping their identity anonymous, and there was no difference as 33.7%, 36.1%, and 30.2% reported it as necessary, somewhat important, and not important at all, respectively. Almost half of the women (52.2%) prefer to give their consent for placenta donation during periodic follow-up of pregnancy. Moreover, most of them prefer to do that with their gynecologist (49.4%) or the principal investigator of the research team (44.6%). Additionally, when participants were asked about the impact of financial compensation on their decision to donate their placenta, 13.4% of women reported that compensation would greatly influence their decision, and 13.1% reported that it would slightly influence their decision. In comparison, 54.4% of them responded that financial compensation would not influence their decision to donate, and 19.1% were unsure.
The vast majority of participants n = 777 (84.2%) wanted to know the nature of the research that will be performed on the placenta before donation, and about 701 women (75.9%) think that they should be informed about any results or developments resulting from the research in which the donated placenta will be used. Participants were asked about their opinion regarding the type of research that can be conducted on donated placentas.
Most of the participants who agreed about donation of their placenta also agreed to use their tissues in neurological injuries research (98%), chronic diseases treatment research (94.8%), regenerative medicine research (90.8%), genetic treatment research (93.2%), and genetic and rare diseases research (93.6%), vaccinations research (83.9%), and environmental Research (68.7%). Furthermore, when participants who refused to donate their placenta cells (N = 674) were asked about their reasons, the reasons were the potential to be used in research that may harm society (65.6%), the potential to be used for commercial purposes (86.5%), desiring to keep it in the cell bank (52.2%), and concerns about sharing data with third parties without consent (74.0%).
Discussion
Several studies have demonstrated that placental-associated tissues offer valuable insights for a wide range of research areas, including cardiovascular diseases, genetics, regenerative and reconstructive medicine, autoimmune disorders, reproductive health, and bioengineering [3, 22]. In the current study, approximately one-quarter of participants expressed a willingness to donate their placentas for research purposes. This low willingness rate may be attributed to the study findings, which showed that most respondents were unaware of the possibility of donating their placenta for scientific research purposes (64.0%). In addition, less than half of them were unaware of the potential benefits of using the placental stem cells in scientific research (43.8%). Furthermore, less than one-quarter (23.2%) believed that donating placentas for research is ethically acceptable. Low willingness (10%) to donate the placenta for medical use was reported in a study from Nigeria [13]. In contrast, in a qualitative study conducted on 19 individuals in Denmark, participants were positive toward the donation of the placenta after birth for medical research [23]. In a study from Brazil they reported that 78% of women supported the use of the placenta in research and medicine [14].
Due to the limited number of studies on placenta donation for research purposes, comparisons with previous literature are difficult. Therefore, the scope of comparisons was expanded to include studies on tissue donation for research. In contrast to the negative attitude towards placenta donation for research observed in the current study, a positive willingness to tissue donation for research including embryonic cord blood has been reported in several previous studies from different countries including Jordan [10, 24, 25]. For example, in a study from Lebanon, more than 50% of pregnant women had a positive attitude toward donating cord blood stem cells after delivery for scientific research purposes [26]. In Poland, a discrepancy in willingness to donate tissues for research purposes was reported according to the type of donated tissues, with high willingness to donate tissues such as hairs and blood, and low willingness to donate tissues such as gametes [27]. A previous study has shown that lack of awareness of research and clinical use of donated tissue is a barrier for donation [28]. The discrepancies in the willingness to donate tissues for research purposes could be due to cultural differences, the type of tissue to be donated, lack of knowledge, and sociodemographic characteristics of the study sample.
Results showed that pregnant women were less likely to donate their placenta for research purposes and preferred to deposit placenta-derived stem cells in a biorepository for future use compared to non-pregnant women. In a study of 150 pregnant women, most participants were unwilling to donate or promote placenta donations and some (19%) believed that placenta donation would affect the child’s future [13]. Therefore, the placenta should not be considered simply medical waste [14]. A deeper understanding of the women’s views on placenta is needed to promote its donation, which could be addressed in future qualitative studies.
Cross-tabulation and regression analysis showed that the willingness to donate placenta was associated with older age, residing in cities, having a high school education or diploma, lack of a background in biomedical science, and having a history of previous pregnancy. Women over the age of 41 were more likely to express willingness to donate their placenta for research purposes. However, this group represents about 12% of the sample, therefore more studies are needed to confirm this finding. A Lebanese study revealed that higher education, age, and urban residence were notable factors influencing the donation of umbilical cord stem cells for medical research [26]. In relation to educational background, a study from Saudi Arabia found that participants with a higher educational level were more inclined to donate tissue for dental research [25]. An Egyptian study identified a notable association between pregnant women’s attitudes toward donation of cord-blood stem cells and both their educational level and place of residence [29]. Thus, similar factors were found to be associated with tissue donation in the region. The study showed that less than one-quarter of respondents considered placenta donation for research to be morally acceptable. In addition, most women emphasized the need to consult Islamic law, seek their husband’s and doctor’s opinions, and consider cultural and social factors before deciding to donate their placenta for research. Among other identified reasons for the unwillingness to donate the placenta for scientific research included concerns about commercial exploitation, potential misuse in harmful research, a preference to store it in a cell bank, and fears of data being shared with third parties without consent. With respect to religion, previous research in Jordan has demonstrated that a significant percentage of obstetricians thought that religious and ethical controversies surrounded umbilical cord blood and tissue donation [10]. It is worth mentioning that using stem cells of human origin for medical and beneficial research is permissible [30]. According to Islamic law (Fatwa), it is permissible to donate non-embryonic stem cells derived from the umbilical cords, placenta or other sources for biomedical research/treatment purposes with appropriate informed consent from donors and without causing any harm [30]. Some Islamic countries, such as Jordan, Iran and Turkey, have their own national guidelines/regulations on the use of stem cells in research [31–33]. According to these guidelines, research on somatic stem cells is permitted. Studies from previous work have also recognized factors contributing to public hesitation to donate bio-specimens for biobanking research, such as lack of trust, socioeconomic and educational disparities, privacy concerns, limited awareness, and vague understanding of biobanking concepts [34–36]. Some studies have shown that cultural believes about health, medicine, and the body can influence the decision of individual to donate tissues/cells for research [27, 37]. Furthermore, participating women stressed the importance of being fully informed about the benefits and risks of the research prior to consenting to donate the placenta. This is consistent with a study conducted in Brazil, where most women highlighted the importance of informed consent and being part of the research process [14]. The ethical aspects of placenta donation, including issues of informed consent, have recently been addressed [6]. In developing countries, obtaining a valid informed consent in research is still a challenge [38, 39]. In addition, protecting privacy and confidentiality, applying culture/religion perspectives, and ensuring clear communication are essential ethical principles that must guide scientific research, particularly in the context of tissue donation [40–42].
The study results showed a discrepancy in women’s opinions about who owns the placenta donated for research. About half of participating women indicated that the researcher owns it, while a similar percentage were unsure. Ownership of tissue donated for research purposes is a complex ethical issue. There is a general agreement that the donor does not retain ownership rights once tissue is donated to a research institution or tissue bank, which then becomes the owner of the tissue [43, 44]. However, this issue should be explained in the informed consent process prior to tissue donation [45, 46]. In addition, researchers should limit the use of donated tissue to the purposes outlined in the consent agreement [45].
Further, the present study shows that 73% of women did not hold a positive attitude toward donating their placentas. It is worth mentioning that the trust between participants and scientists is a dynamic factor in increasing such a positive attitude. In a study conducted in the United States, trust was found to be a determining factor in tissue/blood donation for genetic research [47]. Similar findings have also been reported in studies from Europe [48]. This trust can be built via face-to-face interaction and clear, well-structured written information [23]. Despite its usefulness, some limitations should be acknowledged. Foremost, the survey was distributed through an online platform and accessed via WhatsApp and Facebook, potentially excluding those who do not use social media or lack internet access. This leads to the probability of selection bias and may constrain the generalizability of the results to a broader population. However, with the accessibility of social media platforms to most of the Jordanian public, including women, this limitation is not likely to have a significant impact on the present study. Additionally, the survey relies on a self-reported method, which may lead to response bias. The present study did not assess respondents’ understanding of research venues related to the use of placental tissues. This is because the present study was exploratory, focusing on awareness and attitudes toward donating placentas for research purposes. Moreover, assessing the public (women, in this case) knowledge of related research venues would require a significantly larger number of questionnaire items, which would lengthen the questionnaire and potentially negatively impact the responses. We believe these points could be the matter of future dedicated study.
Conclusion
In conclusion, the levels of Jordanian women’s awareness and positive attitudes regarding placenta donation need to be enhanced. Therefore, it is recommended that health education campaigns and programs be developed by health authorities and the media to enhance women’s awareness and attitudes and modify their willingness toward placenta and tissue donation in scientific research in Jordan. This should also include engaging healthcare providers and having clear guidelines. Future research should focus on gaining a deeper understanding relationships of religion, culture, and ethics in the MENA region to enhance recruitment and participation in tissue donation for scientific research. More generally, there is a need to develop trust between scientists and the general population to enhance research advancements in stem cell, organ donation, and other ethically challenging aspects of research.
Author contributions
All authors have contributed to the study concept, study design, data analysis and interpretations, and reviewing/editing final draft. Y.R. wrote the initial draft. O.K. involved in project management.
Funding
The study was supported by funds from Fogarty International Center (NIH: R25TW010026) and Jordan University of Science and Technology (support ID: 395–2023).
Data availability
The datasets used during the current study are available from the corresponding author on reasonable request.
Declarations
Ethical approval and consent to participate
The study procedure was approved by the Institutional Review Board of the Jordan University of Science and Technology, Jordan (Ref No 2024/377). The study was anonymous, and an online consent was obtained before the participants filled in the study questionnaire.
Consent for publication
Not applicable.
AI use in the writing process
During the preparation of this manuscript, the authors used Grammarly and ChatGPT 4 to assist with language and grammar editing.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used during the current study are available from the corresponding author on reasonable request.