Attitudes, perceptions, behaviours, and concerns of patients listed for kidney transplantation during the COVID-19 pandemic

BACKGROUND: The COVID-19 pandemic caused major disruptions in solid organ transplantation worldwide, particularly in kidney transplantation. Patients on deceased-donor kidney transplant waiting lists represent a vulnerable population due to ongoing dialysis requirements and concerns regarding immunosuppression and infection risk. OBJECTIVE: This study aimed to evaluate the attitudes, behaviors, and concerns of patients on the deceased-donor kidney transplant waiting list regarding kidney transplantation during the second wave of the COVID-19 pandemic. METHODS: A cross-sectional, telephone-based survey was conducted between October and December 2020 at one tertiary care centre in Turkiye. The survey assessed adherence to preventive measures, COVID-19 exposure history, perceptions of renal replacement therapy modalities, attitudes toward kidney transplantation, and transplantation-related concerns during the pandemic. Demographic and clinical data were collected, and responses were analyzed using appropriate statistical methods. RESULTS: A total of 188 transplant candidates (mean age 47.3 ± 13.1 years; 56.4% male) were included. Adherence to preventive measures was reported by 99.5% of participants, and 80.9% followed quarantine rules. Although 76% of participants preferred kidney transplantation before the pandemic, this rate decreased to 55.3% during the pandemic. Despite this decline, 86.7% of participants stated that they would accept a deceased-donor kidney transplant if offered during the pandemic. Only 38.3% reported concerns about undergoing transplantation, with the most common concerns being infection risk related to immunosuppressive therapy, hospital-acquired COVID-19, and donor-related transmission. Shorter renal replacement therapy duration and preemptive transplant status were associated with more favorable attitudes toward transplantation during the pandemic. CONCLUSIONS: Despite pandemic-related uncertainties and concerns, most patients on the deceased-donor kidney transplant waiting list demonstrated a willingness to proceed with kidney transplantation and showed high adherence to preventive measures. These findings highlight the importance of patient education, infection-control strategies, and transparent communication to ensure the sustainability of kidney transplant programs during current and future pandemics.