*Purpose: Kidney transplant is the best choice of treatment for patients with end stage kidney disease. There are medical conditions that may pose an ethical or legal question for kidney allocation like the psychological and mental status of the recipient. Children with severe neurological dysfunction without an anticipated improvement with rehabilitation are examples of this ethical dilemma. On the other hand, the decreased quality of life compared with their peers creates an ethical obligation to provide them with the best of care service including organ transplantation.

*Methods: We retrospectively studied children with kidney transplant in our center who have a background diagnosis of mental retardation with variable severity ranging from mild to severe forms. We recorded their demographic characteristics, duration post-transplant, renal function, incidence of complications including rejection. We briefly interviewed the families during their scheduled outpatient visit asking questions about the changes in their quality of life, social activities, emotional well-being, and we assessed the degree of family support.

*Results: Ten (10) children fulfilled the above criteria. Seven of them were without formal diagnosis and they were labeled as global developmental delay or cerebral palsy. One had Jeune syndrome with mild cognitive dysfunction and he received a combined deceased donor liver and kidney transplant. one had Laurence-moon-Biedl syndrome, and a third had Down syndrome. Most of the children have urological developmental abnormalities as the cause of end stage kidney disease (ESKD). The mean age at transplantation was 7.8 years and they were followed for up to 23 years. Six of them had live donor kidney transplant and four had deceased kidney donation. The mean serum creatinine was 135 umol/l upon last follow up. They didn’t have any rejection episode and they didn’t require prolonged hospitalization except for mild infections (urine and chest infection).The families unanimously assured a positive impact on the family’s quality of life after transplantation. The general misconception about inabilities to follow complex medication regimen and nonadherence in this group of mentally retarded patients is highly challenged in this cohort , as there was a 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.

*Conclusions: 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 good family support even in patients with devastating neurological dysfunction. Organ transplantation gave the families better quality of life and relieved them from the ethical issues surrounding depriving this group from the best care while insuring no waste of precious organ.

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