Factors Affecting Interest in Kidney Transplantation Among Patients on Dialysis

Background: Patient understanding and attitudes toward kidney disease, dialysis, and transplantation significantly impact treatment decisions and outcomes. In clinical practice, some nephrologist notes document patients' reported non-interest in kidney transplantation. This study aimed to explore the underlying reasons for such perceptions and to assess patients’ broader understanding and emotional response to kidney disease and its treatments. Methods: We conducted a cross-sectional survey of patients receiving maintenance dialysis. Participants completed the Brief Illness Perception Questionnaire (BIPQ), a validated 8-item tool that evaluates patients' cognitive and emotional representations of illness. Additionally, we developed a 17-item survey assessing self-reported attitudes toward kidney transplantation on a 3-point Likert scale, with particular focus on patients who expressed no interest in pursuing transplant. Results: The mean age of the study group was 65. Among the 51 individuals surveyed, 12 (24%) were not interested in pursuing kidney transplantation, and 7 (14%) felt neutral about it. Of those not interested, 6 (50%) disagreed that transplantation is the best cure for kidney disease. Two participants (17%) expressed concerns about the cost of the surgery and post-transplant medications. Five participants (42%) perceived the surgery as high-risk. One participant (8%) cited religious beliefs as the reason for not pursuing transplantation. 8 of the 12 (67%) believed they were too old to undergo a transplant; 7 of these patients were over 80 years old, and one was 78. Conclusion: Several factors were identified that influenced patients’ interest in kidney transplantation. Older age was strongly associated with a lack of interest in transplant, with older patients reporting lower perceived suitability for transplant. Comorbid conditions and concerns about overall health, including a perceived inability to tolerate surgery, were frequently cited as barriers. Additionally, perceived surgical risks and concerns about the financial burden of transplantation were significant factors. These findings suggest that addressing both emotional and practical concerns through targeted education and counseling may improve informed decision-making and potentially increase interest in kidney transplantation for dialysis patients.