Introduction: Kidney transplant is the best choice of treatment for patients with end stage kidney disease. Some medical conditions that can pose an ethical and legal questions on kidney allocation, like the psychological and mental status of the recipient. Children with severe neurological dysfunction without any anticipated improvement, can create an ethical dilemma on whether to allocate them a deceased donor kidney transplant knowing the decreased quality of life compared   with their peers. On the other hand there is an ethical obligation to provide the best of care for this vulnerable group.

Methods: We retrospectively studied children with Kidney transplant (KTx) in organ transplant center in Kuwait. Children have a background diagnosis of mental retardation with variable severity ranging from mild to severe, most of the children have urological developmental abnormalities as the cause of end stage kidney disease (ESKD). We included all types of donors, that is live related (LRKTx), live unrelated (LUKTx) and deceased donor (DDKTx). Nine of the children were without a labeled diagnosis (global developmental delay, cerebral palsy) one has Jeune syndrome with mild cognition dysfunction (received a combined deceased donor liver and kidney transplant),one has Laurence-moon-Biedl syndrome, and one Down syndrome received LUKTx.We briefly interviewed the families during their scheduled outpatient visit asking questions about improved quality of life, mainly :social and emotional well-being.

Results: Ten (10) children fulfilled the above criteria were followed up for up to 23 years (the oldest surviving transplant with these criteria in our center) with a mean age at transplant time of 7.8 years. Four (4) (LRKTx), similar number (4) from (DDKTx) and two (2) were (LUKTx).The mean serum creatinine of 135umol/l upon last follow up. Families of the children were interviewed to discuss the impact of kidney transplant on their life: relieve the families from the burden of maintenance HD or PD and provide better quality of life to the children. The general misconception about inabilities to follow complex medication regimen and nonadherence in this group of mentally challenged patients is highly challenged in this cohort, with good support from a caregiver (family member or a house maid) that insured timely given medications on top of good support from our center with follow up and medical education. There were no rejection episodes and no prolonged hospitalization episodes except for mild infections (UTI’s, chest infection).

Conclusion: Mentally challenged individuals should not be denied a chance for kidney transplant based only on their mental condition. Issues of nonadherence can be overcome with stable family support even in patients with devastating neurological dysfunction. It gave the families a better quality of life and relief the ethical issues surrounding depriving this group from the best care while insuring no waste of precious organ.