Barriers to Kidney Transplantation As a Choice of Renal Replacement Therapy

Methods: The target population was all patients with end-stage renal disease undergoing dialysis in Brunei Darussalam who are fit enough to undergo kidney transplant. The shortlisted patients were approached during their hemodialysis sessions or while waiting for clinical reviews in peritoneal dialysis clinics and were given self-administered structured questionnaires.

Results: Out of 348 eligible patients in the country, 226 (64.9%) agreed to participate in the study. The majority of patients (71.2%), especially the unmarried patients (81.5%), cited "lack of donor" as their main reason for not choosing transplant. "Happy with dialysis" (31.9%), "inadequate information" (21.2%), "unwilling to take risk" (26.5%), and "financial problems" (18.1%) were the other common factors identified. A total of 51.8% of the respondents had considered transplant, and 42.5 % of patients had considered the option of commercialization through foreign black market channels. Younger patients (<40 years) on dialysis for less than 5 years with higher education were more likely to consider transplant (P < .05). Likewise, patients who were younger, highly educated, and employed were more likely to choose commercialization (P < .05).

Conclusion: Lack of donor and poor knowledge were the main barriers to patients receiving kidney transplant in the country. Religio-cultural barriers, lack of reimbursement, poor knowledge, and stringent donor criteria contributed to the limited donor pool. Despite universal health coverage for the population, financial and social security factors were still important determinants that influenced recipients' and donors' decisions to reject transplant.