Barriers to Renal Transplant in Pakistan

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.