Background: Transplantation is the renal replacement therapy of choice for patients with end-stage kidney disease. In addition to the survival benefit and better life quality, it confers an economic advantage to the health care system. Although condemned by the international community, transplant tourism and commercial transplantation are still evident. The disparity between organ supply and demand finds an outlet whenever the regulations are less strict.

Objectives: To describe the sociodemographic and clinical characteristics of patients who received a commercial transplant and address the causes to seek commercial transplantation.

Methods: A questionnaire-based survey was done from September 2021 to December 2021 at the outpatient clinic of the Nephrology and Renal Transplantation Center, Baghdad.  In Iraq, renal transplantation is a live donor, blood group compatible program. A central team should approve all donors to ascertain noncommercial conduct. As per Iraqi legislation, renal transplantation services and maintenance immunosuppression are provided free of charge at governmental hospitals. Commercial transplantation is defined as the state of paying a donor at a non-governmental unit. The questionnaire included 15 questions distributed to patients who received transplants at non-governmental units inside Iraq or sought a transplant outside the country. It provided demographic and clinical data and assessed the reason for performing a paid donation. Laboratory data were retrieved from patients records.

Results: Seventy-eight patients accepted to participate in the study. The majority (66/85%) were male, and the study group’s mean age was (43.3+10.8 years). Fifty-four (69.2%) patients were below the college education level, and 47% were unemployed. The cause for ESRD was unknown in 51%.  All donors were live unrelated, and five patients (6.41 %) had their transplants outside Iraq. The duration of the hospital stay was 5-14 days. The time since transplantation was 1 to 5 years.

The reported complications at 1-year post-transplantation were: rejection (15%), wound infection (2.5%), CMV infection (1%), and recurrent disease (1%). The mean serum creatinine at one year was 1.27+0.52 mg/dl. At five years, 14 patients (17.94%) had a diagnosis of chronic allograft dysfunction.

The leading reason for seeking commercial transplantation was the unavailability of the biologically related or unrelated altruistic donor in 74% of the study participants. The average cost was around 30,000-40,000 US$ exceeding the nearly free transplantation services at governmental units.

Conclusion: Unavailability of live related or altruistic donors was the leading cause for seeking commercial transplantation in this sample of Iraqi renal transplant recipients. For a live donor transplant, the early graft function was acceptable. Commercial transplantation adds a lot of financial burden to patients and their families. This emphasizes improving transplantation services and implementing a deceased donor program.