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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2016  |  Volume : 27  |  Issue : 4  |  Page : 769-773
The knowledge, awareness, and acceptability of renal transplantation among patients with end-stage renal disease in Ibadan, Nigeria

1 Department of Surgery, Division of Urology, University College Hospital; Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
2 Department of Medicine (Nephrology Unit), University College Hospital, Ibadan, Nigeria
3 Department of Surgery, College of Medicine, University of Ibadan; Department of Medicine (Nephrology Unit), University College Hospital, Ibadan, Nigeria

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Date of Web Publication5-Jul-2016


Renal transplantation is well established in the USA, Europe, India, and South Africa. However, it is still in its infancy in Nigeria. The objective of our study is to determine the knowledge, awareness, and acceptability of renal transplant among patients with end-stage renal disease (ESRD) and the factors which are responsible for the low level of transplantation in Ibadan, Nigeria. A 15-item pilot-tested questionnaire was administered to willing patients with ESRD seen at the medical outpatient clinic of the University Teaching Hospital, from January to December 2011. There was 81% participation rate of the respondents. Exactly 90.1% had formal education and 44% earned <50,000 naira per month. Seventy-nine percent of respondents was aware of renal transplantation, 70.4% would recommend it to others, and 66.7% accepted renal transplantation; 77.8% would maintain a close relationship with their donors. About 61.7% considered it very expensive, while 33.3% did not know the cost for transplantation. Of the reason for the low level of kidney transplantation in Nigeria, 39.5% had no idea and in 27.2% of the respondents, the fear of death by potential donors may be responsible. Eleven percent of responded that recipients had no money for kidney transplantation and another 11% thought the potential donors would like to be paid for donating their kidneys. Most of the respondents with ESRD were knowledgeable, aware of, and accepted renal transplantation as the next step to treat chronic renal failure. However, majority of these patients could not afford the cost for renal transplantation.

How to cite this article:
Takure A O, Jinadu Y O, Adebayo S A, Shittu O B, Salako B L, Kadiri S. The knowledge, awareness, and acceptability of renal transplantation among patients with end-stage renal disease in Ibadan, Nigeria. Saudi J Kidney Dis Transpl 2016;27:769-73

How to cite this URL:
Takure A O, Jinadu Y O, Adebayo S A, Shittu O B, Salako B L, Kadiri S. The knowledge, awareness, and acceptability of renal transplantation among patients with end-stage renal disease in Ibadan, Nigeria. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2021 Dec 4];27:769-73. Available from: https://www.sjkdt.org/text.asp?2016/27/4/769/185241

   Introduction Top

The incidence of end-stage renal disease (ESRD) in Nigeria ranges between 1.6 % and 12.4% compared to the worldwide annual growth rate of 7%.[1],[2] Most of the potential recipients can only afford three sessions of hemodialysis in the public hospital.[3],[4]

Kidney transplantation offers the best quality of life to the patient with ESRD. There has been an impressive increase per year in the number of kidney transplantations in the USA from 3,786 in 1980 to 17,413 in 2008, compared to Nigeria where a total of 135 renal transplants were performed between the years 2000 and 2010. [5],[6] The stimulus for the success of renal transplantation in the USA is attributed to the passage of the Medicare entitlement legislation in 1972 that paid for maintenance dialysis and renal transplantation. [7] However, in our environment, the patients pay out of pocket for hemodialysis, as well as renal transplantation.

In the public institutions in Nigeria, renal transplant costs between 12,500 and 15,625 USD, while it costs 31,250 USD in the private hospital. [4],[8] Routine renal transplant costs 29,950 USD in South Africa, 21,564 USD in India, and 14,376 USD in Kenya, respectively.

At our University Teaching Hospital, only four renal transplants were performed between 2008 and 2012. Hence, we conducted this study to determine the knowledge, acceptability, and level of awareness of renal transplantation among patients with ESRD in Ibadan, and to determine if the low level of renal transplant is related to poverty or poor socioeconomic status of the recipients.

   Materials and Methods Top

A 15-item questionnaire was designed and a pilot study conducted on ten house physicians and house surgeons to determine its clarity. After making the necessary corrections, these questionnaires were administered to the first 100 consenting newly diagnosed patients with ESRD seen at the medical outpatient clinic from January to December 2011 at our teaching hospital.

Inclusion criteria

Patients with confirmed ESRD who were willing to participate were recruited into the study.

Exclusion criteria

Patients with acute renal failure and those who declined to participate were excluded. Eighty questionnaires were filled and returned. The items evaluated were patient demography, level of education, estimated monthly income, and knowledge of the existence and cost of renal transplantation, acceptability, and reasons for low level of renal transplantation. We also sought for the awareness of the existence of and cost of immunosuppressive drugs.

The data obtained were analyzed using mean, standard deviation (SD) of mean, median, and percentages.

   Results Top

Among the 100 respondents, there was 81% participation rate. The age of respondents ranged from 11 to 72 years, with a mean of 41.3 ± 14.9 years SD and median of 41 years. The male:female ratio was 1.5:1. The duration of illness ranged from 3 to 780 weeks, mean of 72.5 weeks with a median of 21 weeks.

About 61.7% of the respondents were Christians, while 35.8% were Muslims and 2.5% were African traditional worshipers. About 90.1% had the formal education of which 39.5% were traders, and 22.2% were civil servants. Others were artisan workers (13.6%), students (12.3%), and teachers (8.6%). Exactly 44.4% of respondents earned <50,000 nairas (N 50,000 per month), 22.2% did not disclose details about income, 14.8% were unemployed, and only 16% earned between N 51,000 and N 200,000 per month.

As shown in [Table 1], of the 79% respondents who knew about renal transplantation, 61.7% felt it was very costly, 5% of them thought it to be costly, while 33.3% did not know about the cost.
Table 1: The knowledge and awareness of renal transplantation among patients with end-stage renal disease.

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[Table 2] shows that 66.7% of the respondents accepted renal transplantation as a treatment option, while 33.3% did not. Of those who refused renal transplantation, 18.5% were not convinced of the benefits of renal transplantation, while 6.2% respondents would prefer to die rather than undergo kidney transplant. Another 6.2% said their religion and culture forbid transplantation, while 1.2% said the fear of death and advanced age would not make them accept the transplant.
Table 2: Acceptability of renal transplantation among patients with end-stage renal disease.

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Furthermore, 48.1% respondents preferred to have kidney transplantation in Nigeria because of the following reasons: 28.4% said transplantation is cheaper, 14.8% felt it would be an advantage that their relatives would be around them, 3.7% were aware that transplantation was free or subsidized in some hospitals, and 1.2% considered easy access to drugs. Of the 21 respondents who preferred to have transplantation outside Nigeria, 20 of them believed that medical expertise was guaranteed and only one knew that cadaveric donor was available.

As shown in [Table 3], 70.4% of those interested in renal transplantation would recommend it to other patients with ESRD. Around 77.8% of respondents would maintain a close friendly relationship with their donors, and 58% of them would be delighted if they underwent kidney transplantation.
Table 3: The attitudes to renal transplantation among patient with end-stage renal disease.

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Of the reasons for the low level of renal transplantation in Nigeria, 39.5% of the respondents had no idea, while 27.2% thought the prospective donors may be afraid of death and 8.6% felt the donors might have doubts about the survival of the remaining kidney. Other reasons are that the recipients lacked money for transplantation (11.1%), some donors wanted to be paid (11.1%) and that recipients had no money for immunosuppressive drugs (2.5%).

In [Table 4], it is shown that the majority of respondents (56.8%) was not aware of the existence of immunosuppressive drugs, while 43.2% knew about them. About 57.1% of 35 respondents were aware that immunosuppressive drugs would prevent the body from destroying the transplanted kidney.
Table 4: The awareness and knowledge about immunosuppressive drugs.

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   Discussion Top

Patients with long-standing renal impairment had insights of their disease and options of treatment as seen in the high knowledge of renal transplant demonstrated by the respondent in this study. [9]

A previous study in Nigeria showed that health workers had the highest level of awareness about kidney transplantation. [10] Similarly in this study, there was a high knowledge, awareness, and acceptability of renal transplantation by the respondents. This may be attributed to the majority of them having formal education.

In this study, a high proportion of the respondents accepted renal transplantation and would recommend it to others irrespective of their religious background. It was reported that both major religions, Islam and Christianity, supported renal transplant based on the individual altruistic belief in saving another life. [11] This is strengthened by the United Kingdom Muslim Law Council in 1996 and the Jehovah Witness in 1980. Both of which declared their support for organ donation and transplantation. [11]

Although the cost of renal transplantation in Nigerian public hospitals is similar to that in Kenya National Hospital, the latter performed a larger number of renal transplantations in less than a year of commencement due to partnership with pharmaceutical companies. In fact, a public institution in Nigeria, over a ten-year period, performed only 35 renal transplantations. [6] The average cost of renal transplantation is 15,625 USD in Nigeria, but in this study, only 2.4% earned enough to pay for the transplant procedure, while the majority of the respondents earned <3750 USD per annum.

In this study, majority of the respondents were determined to maintain a "close friendly relationship" with their prospective donors. This is in consonance with reports that thorough screening of recipient and donor went a long way in ameliorating the psychological problems associated with renal transplantation. [12] This suggests that the recipients are likely to comply with strict follow-up protocols and subsequently ensure prolonged graft survival. On the other hand, the donor will wish to see the prolongation of a worthy healthy life of the recipient. The outcome of this recipient-donor relationship may go a long way in encouraging more willing altruistic donors in our environment.

Some respondents expressed the desire to be paid for the donation in addition to the fear of adverse health consequences. [10] The implications of the aforementioned are that donors must be well motivated and enlightened about the ideologies and effects of kidney donation and assured of adequate follow-up.

   Conclusion Top

Majority of the respondents with ESRD are very knowledgeable, aware of, and accepts renal transplantation but cannot afford it. We recommend that the government, insurance, and charitable organizations should come to the aid of these financially handicapped patients with ESRD.

Conflict of interest: None declared.

   References Top

Odubanjo MO, Oluwasola AO, Kadiri S. The epidemiology of end-stage renal disease in Nigeria: The way forward. Int Urol Nephrol 2011;43:785-92.  Back to cited text no. 1
Moeller S, Gioberge S, Brown G. ESRD patients in 2001: global overview of patients, treatment modalities and development trends. Nephrol Dial Transplant 2002;17(12):2071-6.  Back to cited text no. 2
Arije A, Kadiri S, Akinkugbe OO. The viability of hemodialysis as a treatment option for renal failure in a developing economy. Afr J Med Med Sci 2000;29:311-4.  Back to cited text no. 3
Bamgboye EL. Hemodialysis: Management problems in developing countries, with Nigeria as a surrogate. Kidney Int Suppl 2003;83:S93-5.  Back to cited text no. 4
USRDS 2010 Annual Data Report. United States Renal Data System. Available from: http://www.usrds.org/adr.htm. [Last accessed on 2010 Nov 08].  Back to cited text no. 5
Takure AO, Alikha SO, Onuora VC. Knowledge and level of awareness of renal transplant among medical students in Nigeria. Transplant Res Risk Manage 2010;2:59-64.  Back to cited text no. 6
Goodman WG, Danovitch GM. Options for patients with kidney failure. In: Danovitch GM, edr. Handbook of Kidney Transplantation. 4 th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1-22.  Back to cited text no. 7
Badmus TA, Arogundade FA, Sanusi AA, et al. Kidney transplantation in a developing economy: Challenges and initial report of three cases at Ile Ife. Cent Afr J Med 2005;51:102-6.  Back to cited text no. 8
Urstad KH, Andersen MH, Øyen O, Moum T, Wahl AK. Patients′ level of knowledge measured five days after kidney transplantation. Clin Transplant 2011;25:646-52.  Back to cited text no. 9
Aghanwa HS, Akinsola A, Akinola DO, Makanjuola RO. Attitudes toward kidney donation. J Natl Med Assoc 2003;95:725-31.  Back to cited text no. 10
Oliver M, Woywodt A, Ahmed A, Saif I. Organ donation, transplantation and religion. Nephrol Dial Transplant 2011;26:437-44.  Back to cited text no. 11
Sajjad I, Baines LS, Salifu M, Jindal RM. The dynamics of recipient-donor relationships in living kidney transplantation. Am J Kidney Dis 2007;50:834-54.  Back to cited text no. 12

Correspondence Address:
A O Takure
Department of Surgery, Division of Urology, University College Hospital, Ibadan
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DOI: 10.4103/1319-2442.185241

PMID: 27424696

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  [Table 1], [Table 2], [Table 3], [Table 4]

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