PurposeInequities for sexual- and gender-minoritized (SGM) populations in organ and tissue donation and transplantation (OTDT) have been identified. We aimed to understand the awareness and attitudes of community members who are SGM regarding current SGM-relevant policies, policy gaps, and policy alternatives in Canadian OTDT systems.MethodsWe conducted an online, cross-sectional, Canada-wide survey of members of the Two-Spirit, gay, bisexual, transgender, queer, intersex and more (2SGBTQI+) communities (June–September 2024). Questionnaire development adhered to current survey science recommendations. We present descriptive data as counts and proportions.ResultsWe analyzed responses from a convenience sample of 2,276 participants from across Canada. Most participants self-identified as White cisgender gay men. Prior to questionnaire completion, only 17% (257/1,497) of participants were aware that men who have sex with men are considered “increased infectious risk donors” in OTDT and cannot donate tissues, and 20% (302/1,512) were aware that they may only donate organs if the benefit to the recipient is deemed to outweigh the risk. Of the respondents, 18% (270/1,535) did not realize that potential donors are screened on the basis of sex assigned at birth as opposed to self-identified gender identity. On average, 23% (1,406/6,084) of participants perceived these policies as nondiscriminatory. Of the respondents, 60% (1,865/3,115) supported gender-neutral, behavior-focused donor risk assessments that were data-driven. Most participants reported a willingness to donate organs (79%; 1,237/2,276) and tissues (72%; 1,123/2,276) after death.ConclusionsPeople in Canada who self-identify as 2SGBTQI+ perceived current OTDT policies to be discriminatory and in need of equitable revision. Evidence-based behavioral and gender-neutral donor risk criteria were preferred over identity-based criteria. The majority of survey participants who identify as SGM were willing to donate organs and tissues despite current system inequities. Health Canada should revise current donor risk assessment criteria to ensure they are data-driven and optimize access and safety to OTDT in Canada.