Physicians attitudes toward living non‐related renal transplantation (LNRRT)

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Abstract
Renal transplantation is considered now the definitive treatment for patients with end‐stage renal disease (ESRD). Unfortunately, the worldwide shortage of kidneys remains the most important obstacle to transplantation. In developing countries, including those of the Middle East, the shortage is even more dramatic. Despite great efforts to establish and maintain successful transplant centers, the number of kidneys that have been transplanted in the last few years has actually declined. The lack of a dependable kidney source played well into the hands of unscrupulous entrepreneurs who started brokerage of organs for profit. In this practice, patients with ESRD travel to India and other countries to purchase kidneys from living genetically non‐related poor donors. Patient care was therefore relegated to the laws of the marketplace and both patients and donors were exploited to maximize profit. Additionally, reported results of this type of transplantation were inferior to those of other types of transplantation. Not unexpectedly, these issues have created intense controversy among transplant physicians and the general public in which moral, ethical and medical issues were debated. To investigate these issues, we conducted a large multicenter study in Saudi Arabia, Bahrain and Egypt. In the first phase of this study, we surveyed 50 institutions regarding their attitude toward LNRRT, of which 22 responded. The results of our survey clearly show that patients with ESRD take the initiative in seeking LNRRT despite physician discouragement and significant financial burden. The transplants were performed expeditiously and patients were sent back to their home countries within a short period of time. Seventy five percent of centers thought that the medical report that was sent with patients was poor or only fair. Responding centers feel that patient education is inadequate, and their compliance with medications and follow‐up visits are poor or only fair. More than half of the centers thought that LNRRT is associated with high mortality. Importantly, 52% of centers reluctantly have come to accept this type of transplantation but thought it should be regulated. All centers suggested that more should be done to improve public education about this type of transplantation. The public should be convinced that expansion of local cadaveric renal transplantation programs would eliminate the need for commerce in human organs.

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