Knowledge, attitude and perception of kidney transplantation among people living with chronic kidney disease, their caregivers and the general population in Kumasi, Ghana: a cross-sectional study

Kidneys are the body's quiet filters, working constantly to clean the blood and remove waste. When these organs fail, a condition known as end-stage kidney disease, the body cannot survive without help. The most effective way to restore health and extend life is a kidney transplant, where a healthy kidney from another person takes over the work. While this procedure is a standard, life-saving treatment in many parts of the world, it remains rare in Ghana. Most people with kidney failure there rely on dialysis, a machine that cleans the blood, or on conservative care, because transplants are difficult to access and often too expensive. Before a country can build a robust system to offer these life-saving surgeries, it must understand what its people think about them. Do they know how the procedure works? Do they trust it? Do they fear it?

A team of researchers in Kumasi, Ghana, set out to answer these questions by listening to three distinct groups: people living with chronic kidney disease, the family members who care for them, and the general public. They conducted a survey in early 2023, speaking directly with 424 individuals. The goal was not just to count how many people knew the facts, but to understand their feelings and beliefs. The researchers found a striking disconnect. The vast majority of those surveyed, nearly 87 percent, knew enough about kidney transplants to be considered well-informed. They understood the basics of the procedure and its benefits. Yet, despite this knowledge, their attitudes were often hesitant, and their perceptions were frequently negative. Only about half of the respondents felt positively about the idea of a transplant, and fewer than 40 percent viewed it as a good option.

The study revealed that knowing the facts does not automatically lead to trust or willingness. Among the people living with kidney disease, older age was linked to a more negative view of transplantation. In contrast, within the general population, having a monthly income above 500 Ghanaian cedis was strongly associated with a more positive attitude and a better perception of the procedure. This suggests that financial security may play a larger role in shaping hope and acceptance than medical knowledge alone. When asked why they would not choose to donate a kidney while alive, fear of surgery was the most common reason, cited by nearly half of all respondents. Many also worried that they were too young to donate or feared that their remaining kidney might fail later in life. Interestingly, religious beliefs were rarely a barrier; only a small fraction of people said their faith forbade donation.

The willingness to help a family member varied significantly depending on who was asked. Caregivers, who spend their days supporting a loved one with kidney disease, were the most willing to donate, with over two-thirds saying they would give a kidney to a relative. People living with the disease themselves were much more hesitant, with less than 40 percent expressing the same willingness. This gap may reflect the immense physical and emotional toll that caregiving already takes, or perhaps a deeper personal fear of the risks involved. The general public showed a clear preference for helping those they know; they were much more likely to agree to donate to a relative than to a stranger. Furthermore, the idea of donating organs after death was unpopular, with many people believing their bodies would be disrespected if they chose to donate.

The researchers concluded that while the people of Kumasi are well-educated about kidney transplants, the path to building a sustainable transplant program in Ghana is blocked by fear, financial concerns, and deep-seated misconceptions about the risks. The study did not find that a lack of information was the problem. Instead, it highlighted that even when people understand the science, they may still feel that the risks are too high or the costs too great. To move forward, the authors suggest that future efforts must go beyond simple education. They need to address the specific fears and economic realities that shape how people feel about this life-saving treatment. The data shows that knowledge is present, but the bridge to acceptance has not yet been built.