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. 2025 May 26;17(5):e84850.
doi: 10.7759/cureus.84850. eCollection 2025 May.

Barriers to Renal Transplant in Pakistan

Aurangzeb Afzal  1 , Muhammad Ahmad Rauf  1 , Zohra Khanum  2 , Hafiza Sumaira Rahman  1 , Zahid Rafique  1 , Areeba Gulzar  1 , Waqas Rasheed  1 , Jehangir Afzal Mobushar  3 , Beenish Abbas Bajwa  4
Affiliations

Barriers to Renal Transplant in Pakistan

Aurangzeb Afzal et al. Cureus. .

Abstract

Background Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD), offering better survival and quality of life compared to dialysis. However, in Pakistan, multiple socio-economic, legal, and healthcare-related barriers limit the accessibility of kidney transplants. The objective of the current study is to evaluate the barriers to kidney transplant among ESRD patients in Pakistan. Methods A cross-sectional study was conducted among 244 ESRD patients undergoing maintenance haemodialysis (MHD) in three major hospitals in Lahore, Pakistan. Data were collected through structured interviews using a comprehensive questionnaire covering socio-demographics, medical history, transplant awareness, donor availability, and legal knowledge. Results The mean age of participants was 46 ± 15 years, with 57.8% males and 42.2% females. Awareness of kidney transplantation was low, with only 29.9% expressing interest in undergoing transplantation. Only 5.7% had a legally eligible donor, primarily siblings (28.5%) and spouses (14.2%). Awareness of the Punjab Human Organ Transplant Authority (PHOTA) was poor (15.6%). Legal knowledge gaps were prominent, as only 9.8% knew that unrelated donors were prohibited by law and 4.9% were aware that financial compensation for organ donation is illegal. Economic constraints, lack of awareness, religious misconceptions, and gender disparities were identified as key barriers. Moreover, 3.3% of potential donors initially agreed but later withdrew, and 2.5% were rejected during medical evaluations. Conclusion The study highlights significant socioeconomic, cultural, and legal barriers to kidney transplantation in Pakistan. Targeted awareness campaigns, improved healthcare infrastructure, legal reinforcement, and financial assistance programs are needed to bridge the gap between demand and access to kidney transplants. Addressing these barriers can enhance transplantation rates and improve patient outcomes.

Keywords: cultural barriers; kidney transplant; patients; punjab human organ transplant authority; socioeconomic status.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board, Services Institute of Medical Sciences, Lahore, Pakistan, issued approval IRB/2023/1127/SIMS. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board, Services Institute of Medical Sciences, Lahore, Pakistan (IRB/2023/1127/SIMS) dated 13-06-23, and all participants provided informed consent prior to participation. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Knowledge of kidney transplant laws and regulations
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