Development of the AP-DONOR Score for Psychological Barriers to Organ Donation: A Preliminary Psychometric Study Among Romanian Medical Students

Background: The persistent shortage of donor organs remains a major public health challenge. Medical students are an important target population because knowledge of brain death, emotional responses, and institutional trust may influence personal donation decisions and future clinical practice. Existing measures assess general donation attitudes or death anxiety but do not isolate apprehension related to brain-death determination and institutional trust. This Phase I study developed the seven-item Assessment of Psychological Apprehension toward Organ Donation (AP-DONOR) Score and performed its preliminary psychometric evaluation. Methods: This analytical cross-sectional derivation study included 549 second-year medical students from “Dunărea de Jos” University of Galați, Romania. The questionnaire was administered 7–10 days after a standardized curricular module on brain death, organ procurement, consent, and family communication. The sample was randomly divided for exploratory (n = 275) and confirmatory (n = 274) factor analyses, using Pearson correlations for EFA and WLSMV estimation for CFA. Internal consistency, factor structure, and associations with donation willingness were assessed. Results: Among the 548 participants with a valid willingness response, 422 (77.0%) were willing to donate their organs post-mortem. Two related dimensions emerged: Diagnostic Fear and Anxiety (DFA; α = 0.74, ω = 0.75) and Institutional and Social Mistrust (ISM; α = 0.78, ω = 0.79; inter-factor r = 0.38). Confirmatory factor analysis showed good fit (CFI = 0.981; TLI = 0.969; RMSEA = 0.039, 90% CI 0.000–0.078; SRMR = 0.031), superior to a one-factor model (CFI = 0.803; RMSEA = 0.123), with composite reliability of 0.774 and 0.824 and average variance extracted of 0.534 and 0.540. Willing donors had significantly lower DFA and ISM scores (p < 0.001), with moderate-to-large item-level effect sizes (Cohen’s d = 0.74–1.13). Conclusions: The AP-DONOR Score is a feasible, concise instrument capturing two potentially modifiable dimensions of donation-related apprehension. Further independent validation is required to establish test–retest reliability, convergent validity, measurement invariance, and clinically meaningful thresholds.