KNOWLEDGE, ATTITUDES, AND PERCEPTIONS TOWARD KIDNEY TRANSPLANTATION AND LIVING KIDNEY DONATION IN RENAL FAILURE PATIENTS AND FAMILY MEMBERS : A SURVEY FROM TWO TEACHING HOSPITALS IN ANTANANARIVO, MADAGASCAR

Kidney transplantation is currently one of the leading therapeutic options for patients with end-stage renal disease (ESRD), offering meaningful improvements in quality of life and long-term survival. Few studies have assessed the opinions of patients and their families regarding kidney transplantation in this setting. The primary objective is to evaluate knowledge, attitudes, and perceptions toward kidney transplantation and living kidney donation among  patients and their families.

A descriptive, analytical, multicenter survey was carried at two University Hospitals in Antananarivo including Joseph Raseta Befelatanana and Joseph Ravoahangy Andrianavalona University Hospitals. It was concucted over a period of six months (January 2019 to June 2019). Participants included adults with Chronic Kidney Disease CKD staged 4 and 5, on or off dialysis, and their family members. Exclusions were incomplete records. Variables included : socio-demographic characteristics ; knowledge about kidney transplantation (level, sources, and quality of received information); knowledge of someone transplanted ; acceptance of transplantation and kidney donation ; and factors related to refusal of surgical intervention. The collected data will be entered and analyzed using SPSS software, version 25.0. All statistical results were calculated with 95% confidence intervals. Differences are considered statistically significant when the p-value is less than 0.05, which corresponds to a 5% risk of error

In 110 out of 114 CKD patients and 99 out of 104 family members completed the survey (responses rates 96.5% and 86.8%). Median age was 51.1 years (range 22–78). Sex ratio was 1.2. Among patients, 93.6% were in End Stage Renal Disease (ESRD) and 58.3% were on hemodialysis. Patients and families had heard about kidney transplantation and living kidney donation respectively in 60% and 55.5%. Information received was incomplete and insufficient in 47% and 67.3% of respondents. Information sources were healthcare professionals in 34.8% and media in 33.3%. Patients and family members toward attitudes of kidney transplantation and kidney donation by sociodemographic characteristics are summirised in Table 1. Acceptance to kidney transplantation was seen in 63,3% and kidney donation in 58,6% (Figures 1 and 2). Our results observed that 33% of the patients reported that they knew a relative or someone kidney transplanted. A favorable attitude toward transplantation and donation was significantly associated with having complete information (p=0,007), knowing a relative or a transplanted person(p=0,03), and higher education level of family members (p=0,01). Barriers cited included the high cost of treatment and fear of surgical intervention and  its postoperative complications, age related concern, moral, cultural and religious frameworks. Details are seen in Figure 3.

This study highlights that information and awareness about kidney transplantation and living kidney donation remain insufficient for patients and family members. Healthcare teams should prioritize education to explain both benefits and risks of transplantation. The findings support a national strategy for an early therapeutic education on kidney transplantation at CKD stage 4 and call for urgent involvement of health authorities to establish a clear legal framework that makes renal transplantation accessible, ethical, and sustainable locally.