Farah S S, Alhaji M M, Ahmed D, Alam S, Johan N H, Zulkipli I N, Khalil M A, Tan J
PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam.
Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan, Brunei Darussalam.
Transplant Proc. 2018 Dec;50(10):3165-3171. doi: 10.1016/j.transproceed.2018.07.005. Epub 2018 Jul 7.
Brunei Darussalam has a live related kidney transplant program since 2013. Uptake of transplant remains poor in the country despite full government subsidy for health care. This study aims to assess barriers and factors affecting patients' preference toward dialysis over transplant as their choice of renal replacement therapy. It is hoped that the study can provide a better insight into the poor uptake of transplant in the country.
The target population was all patients with end-stage renal disease undergoing dialysis in Brunei Darussalam who are fit enough to undergo kidney transplant. The shortlisted patients were approached during their hemodialysis sessions or while waiting for clinical reviews in peritoneal dialysis clinics and were given self-administered structured questionnaires.
Out of 348 eligible patients in the country, 226 (64.9%) agreed to participate in the study. The majority of patients (71.2%), especially the unmarried patients (81.5%), cited "lack of donor" as their main reason for not choosing transplant. "Happy with dialysis" (31.9%), "inadequate information" (21.2%), "unwilling to take risk" (26.5%), and "financial problems" (18.1%) were the other common factors identified. A total of 51.8% of the respondents had considered transplant, and 42.5 % of patients had considered the option of commercialization through foreign black market channels. Younger patients (<40 years) on dialysis for less than 5 years with higher education were more likely to consider transplant (P < .05). Likewise, patients who were younger, highly educated, and employed were more likely to choose commercialization (P < .05).
Lack of donor and poor knowledge were the main barriers to patients receiving kidney transplant in the country. Religio-cultural barriers, lack of reimbursement, poor knowledge, and stringent donor criteria contributed to the limited donor pool. Despite universal health coverage for the population, financial and social security factors were still important determinants that influenced recipients' and donors' decisions to reject transplant.
自2013年以来，文莱达鲁萨兰国开展了活体亲属肾移植项目。尽管政府为医疗保健提供全额补贴，但该国的移植接受率仍然很低。本研究旨在评估影响患者选择透析而非移植作为肾脏替代治疗方式的障碍和因素。希望该研究能够更好地洞察该国移植接受率低的原因。
目标人群为文莱达鲁萨兰国所有正在接受透析且身体状况足以接受肾移植的终末期肾病患者。在入围患者进行血液透析期间或在腹膜透析诊所等待临床检查时与他们接触，并给予自行填写的结构化问卷。
该国348名符合条件的患者中，226名（64.9%）同意参与研究。大多数患者（71.2%），尤其是未婚患者（81.5%），将“缺乏供体”作为不选择移植的主要原因。其他常见因素包括“对透析满意”（31.9%）、“信息不足”（21.2%）、“不愿冒险”（26.5%）和“经济问题”（18.1%）。共有51.8%的受访者考虑过移植，42.5%的患者考虑过通过国外黑市渠道商业化的选择。透析时间少于5年、受过高等教育的年轻患者（<40岁）更有可能考虑移植（P < 0.05）。同样，年轻、受过高等教育且有工作的患者更有可能选择商业化（P < 0.05）。
缺乏供体和知识匮乏是该国患者接受肾移植的主要障碍。宗教文化障碍、缺乏报销、知识匮乏和严格的供体标准导致供体库有限。尽管全民享有医疗保险，但经济和社会保障因素仍然是影响受者和供体拒绝移植决定的重要因素。
