Signatures versus Understanding? Bridging the Literacy Gap in Kidney Transplant Consent in Resource-constrained Settings

Abstract Informed consent for kidney transplantation in resource-constrained settings frequently transitions from a meaningful ethical dialogue into a perfunctory administrative task. While clinical outcomes in emerging transplant centers continue to improve, a significant literacy gap remains, where the acquisition of a signature does not guarantee a patient’s true comprehension of the lifelong implications of the procedure. This short communication highlights the critical divergence between legal authorization and medical understanding, particularly in populations with diverse linguistic backgrounds and varying levels of health literacy. We propose a transition toward a communication-first model, utilizing visual decision aids, the teach-back method, and culturally adapted vernacular tools to ensure patient autonomy. By prioritizing cognitive understanding over mere documentation, clinicians can mitigate risks of posttransplant nonadherence and donor regret. Ultimately, streamlining the consent process through these low-cost, high-impact communication strategies is essential for maintaining the ethical integrity and long-term success of transplant programs in the Global South.