*Purpose: Lack of knowledge or misunderstanding of organ donation may underlie physician unwillingness to refer patients for organ donation. We examined baseline knowledge and beliefs about organ donation in a cohort of second year medical students with the aim of examining the interaction of knowledge and beliefs at this early stage of training.

*Methods: A previously validated questionnaire, that includes 12 questions addressing specific knowledge about organ donation as well as attitudes and comfort with knowledge, using a 5 point Likert scale was distributed to 190 Second Year Medical Students at a required session, prior to their Neuroscience unit. Students returned the survey anonymously to a box.

*Results: : 132 students returned the survey. There were 64 women (48.5%) and 66 men (50%). 49% of students reported not knowing the definition of brain death and 61% did not know or believed an EEG was not necessary for the diagnosis. 46% had not signed an organ donor card and 57% had not discussed organ donation with their families. Students who had not signed their donor card were more likely to disapprove of organ donation (r=0.37, p<0.0001), and less likely to agree to donation of organs of a child (r=0.55, p<0.0001) or family member (r=0.52, p<0.0001), and more likely to agree that the removal of a person’s organs before their heart stops is a violation of their rights (-0.18, p=0.04). Although students who signed their organ donor card did not report feeling more prepared to deal with organ donation as a physician or being more knowledgeable about the allocation process or the criteria for brain death, they were more likely to answer correctly when asked to identify potential patients as organ donors (p<0.005 by Chi Square analysis for all 7 scenaria, including anencephaly, barbiturate overdose, SAH, pediatric donor, hypotension with pressor use, post arrest and elderly donor ), suggesting that they had better understanding of the process than students who had not signed their card.

*Conclusions: 50% of students who were more than half way through their pre-clinical Medical School training, but had not been exposed to neuroscience, had not signed an organ donor card. Students who signed their card were more likely to approve of organ donation, and more likely to refer a child or family member for donation. They were also more knowledgeable about organ donation although they were not confident in their knowledge. Many students enter medical school with pre-existing biases and little knowledge regarding organ donation. Educational sessions should be incorporated early into training in order to avoid reinforcement of these biases.

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