The awareness of organ donation among health professionals is important at the time of transplant promotion. In this sense, the training and awareness of the professionals in training is fundamental. To analyze the differences in the attitude toward organ donation and the factors that condition it among medical students of regions with donation rates >50 donors per million population (pmp) with respect to those with rates <40 donor pmp. Population under study: medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: Group 1 (n = 1136): students in universities of regions with >50 donors pmp. Group 2 (n = 2018): university students in regions with <40 donors pmp. Assessment instrument: attitude questionnaire for organ donation for transplant PCID-DTO-Ríos. The attitude toward organ donation for transplantation is similar among students from the autonomous communities with >50 donors pmp and with <40 donors pmp. In group 1, 79% (n = 897) of students are in favor compared with 81% (n = 1625) of group 2 (P=.29). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): sex, having discussed transplantation with family and as a couple, considering the possibility of needing a transplant, involvement in prosocial activities, attitude toward the manipulation of corpses, knowledge of the brain death concept, and religion. The awareness of organ donation in Spanish medical students is quite homogeneous and is not related to the local donation rates of each region. •The awareness of organ donation in Spanish medical students is quite homogeneous and is not related to the local donation rates of each region.•The attitude toward organ donation for transplantation is similar among students from the autonomous communities with > 50 donors per million population (pmp) and with < 40 donors pmp.•In both groups, the attitude toward own organ donation at death is related to all psychosocial variables analyzed.•Only a few years ago pmp donation ceilings were proposed, and now they are currently exceeded.•Obtaining high donation rates does not guarantee its persistence over time, so the process must be permanently promoted.