Beyond the gift: donor motivations and family experiences as drivers of body donation programs.

Background: Body donation to science provides indispensable resources for medical education and research, yet shortages remain widespread. Understanding the interplay between donor motivations and family experiences is essential to sustain donation programs and to position them as public health education initiatives. Methods: We conducted a mixed-methods exploratory study at the University of Liège (Belgium), combining self-administered questionnaires from registered donors (n = 104) with surveys of donor families (n = 10). Quantitative data were analyzed descriptively and with nonparametric tests, while qualitative responses underwent thematic content analysis. The Behavior Change Wheel (BCW), the Protection Motivation Theory (PMT), and prosociality frameworks guided interpretation. Results: Scientific utility was the leading motivation (56.7%), followed by symbolic meaning, altruism, and gratitude. Nearly all donors informed their relatives (96.2%), whose reactions varied by occupational category. Families expressed overall satisfaction but frequently described a "double bereavement" at death and at restitution. Word-of-mouth was the predominant channel of information (52.9%), though many respondents called for broader outreach. Within the PMT framework, donation was driven by high perceived response efficacy, reinforced self-efficacy (accessible information, family dialogue), and limited but salient emotional costs. Prosocial and altruistic factors (empathy, responsibility, symbolic legacy) complemented protective motivations, framing donation as a costly yet meaningful prosocial act. Discussion: Integrating PMT and prosociality provides a novel model to explain why donation simultaneously addresses a perceived systemic shortage (protective motive) and a desire to contribute to the common good (altruistic motive). Family support functions as a key moderator, amplifying motivation and reducing perceived costs. Within the BCW, interventions should enhance capability (clear communication, bereavement support), expand opportunity (media campaigns, standardized rituals, faculty presence), and sustain motivation (student/educator testimonials, family recognition). Conclusion: Body donation programs extend beyond logistics: they act as population-level health education and promotion initiatives, normalizing dialogue on death, solidarity, and legacy. Embedding integrative behavioral models into program design can strengthen institutional trust, support families, and ensure the sustainability of body donation worldwide.