Barriers to Kidney Transplantation in Urban Hemodialysis Centers in Pakistan: A Cross-Sectional Study

Abstract

Background and aims: End-stage kidney disease is a global health challenge that has greatly affected low-income and middle-income countries. While a living donor kidney transplant (LDKT) is the most optimal treatment for end-stage kidney disease, many medical and nonmedical barriers persist which hinder transplant rates. This study aims to identify the various medical, psychological, and socioeconomic barriers to LDKT among patients in urban hemodialysis centers in Pakistan.

Methods: A cross-sectional study of patients undergoing hemodialysis in urban hospitals across three urban cities in Pakistan was conducted. Participants were given a structured questionnaire addressing demographics, medical history, socioeconomic status, and transplantation awareness.

Results: The median age was 54 years (IQR 20), with 56.2% male participants. Barriers were identified as socioeconomic (61.4%), medical (32.6%), and psychological (6%). Significant differences in median age were observed across groups (P < .01), with socioeconomic barriers associated with younger patients (median age 49 years) compared to medical (median 63 years) and psychological (59 years) barriers. Patients with socioeconomic barriers were younger (P ≤ .01), had lower income (P = .02), and had relatively lower rates of marriage (P = .02) compared to those in other categories. Lack of donors and lack of financial resources were the most common barriers, cited by 50.2% and 50% of participants, respectively.

Conclusions: Socioeconomic barriers are the leading obstacles to LDKT in Pakistan. Efforts must be made to address these barriers, such as a deceased donor program, financial aid, and improving patient knowledge about LDKT. Further studies should explore rural populations and psychological barriers in greater depth.