BARRIERS TO TRANSPLANTATION IN PATIENTS ON MAINTENANCE HEMODIALYSIS: A CROSS-SECTIONAL ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICES

Introduction:

Renal transplantation is the treatment of choice for patients requiring Renal Replacement Therapy. Patient survival and quality of life after renal transplant is far better than dialysis.  However, factors such as a lack of education and awareness regarding transplantation, lack of a reliable source of information and general distrust of the medical system pose challenges for patients to consider kidney transplantation as a modality for renal replacement therapy.

Methods:

This is a cross-sectional study. A questionnaire with 30 questions was developed with the help of 4 nephrologists. It consisted of 4 subsections: Demographic data, Knowledge, Attitude and Practices (KAP) towards kidney transplantation, KAP towards living donor kidney transplantation, and KAP towards deceased donor kidney transplantation. A pilot study was undertaken with 10 random volunteers from the study group to ascertain the comprehensibility and appropriateness of the questionnaire. The questionnaire was circulated in 3 different languages: English, Hindi and Gujarati to patients undergoing hemodialysis at Institute of Kidney Disease and Research Centre-Institute of Transplantation Sciences and associated Gujarat Dialysis Program (GDP) centres. Patients were asked to fill the questionnaire with the help of attendants and dialysis staff in a language they were comfortable in.

Results:

We received a total of 4146 responses. 67.37% of the patients were males, 32.58% were females and 0.05% were others. The average age was 46 years. 53.38% of the patients wanted to get a kidney transplant, 26.27% didn’t want a transplant and 20.35% were unsure. Only 11.41% were undergoing an evaluation for living donor kidney transplant, and 12.91% were enlisted for a deceased donor kidney transplant. Only 33.33% of the patients thought they had full information regarding kidney transplantation. 60.32% of the patients thought survival was longer after getting a transplant, and 63.72% of the patients thought that the quality of life after getting a transplant was better than staying on dialysis. 49.47% of the patients agreed that high cost was a barrier to transplantation, and 71.54% of the patients thought that dialysis was cheaper than getting a transplant. Only 30.68% of the patients were willing to accept organ from a family member. 50.38% of the patients thought kidney donation is risky for the donor,  23.03% of the patients thought a donor can not work for several months after transplant, and 16.73% of the patients thought a donor can never work after kidney donation.

Conclusions:

While a majority of the patients are keen on undergoing renal transplantation, very few patients have started the evaluation process for living or deceased donor kidney transplantation. Most of the patients are aware of the benefits of undergoing renal transplantation but feel they have inadequate information. Efforts, such as conducting camps, training dialysis staff to provide counselling, use of media should be undertaken to raise awareness regarding benefits of transplantation, the process and costs involved and risk to donor after nephrectomy. Government financial support policies need to be formed to also include the hidden costs that patients have to bear. A closer look at the healthcare system is require to overcome the general mistrust that patients have in the organ allocation system. A more transparent and patient friendly approach is required to be able to provide access to transplantation to all.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.