Chinese people are consistently reported to be less likely to commit to posthumous organ donation than the Westerners. This study aims at investigating how death anxiety may hinder them from expressing their willingness to donate organs. Among 290 Hong Kong Chinese adults (age ≥ 25 years), a higher level of death anxiety was associated with a greater expectation of medical neglect and a lower level of self-efficacy. Moreover, a higher level of death anxiety was also correlated with a lower likelihood of donor card signing and discussion of organ donation. The results of regression analyses suggested a mediating role of self-efficacy on the relationship between death anxiety and these behaviors. That is, death anxiety, by lowering one's perceived self-efficacy, reduces his/her likelihood to sign the donor card or to tell his/her donation decision. Findings suggest that death education program should be included in promotion campaigns for Chinese adults. Copyright © Taylor & Francis Group, LLC.