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Marital discordance is known to be associated with morbidity and mortality in chronically ill patients, but its correlates have yet to be fully addressed in renal recipients. The aim of this study was to assess marital relationship and its correlation with patients' morbidity after kidney transplantation. Ninety-three married Iranian kidney recipients who had undergone kidney transplantation in Baqiyatallah Hospital, Tehran, Iran, were assessed for marital adjustment with the Revised Dyadic Adjustment Scale (RDAS). The patients' quality of life (Short From-36), anxiety and depression (Hospital Anxiety and Depression Scale), and sexual relationship (Relationship and Sexuality Scale) were also evaluated. Eighty-seven subjects (93.5%) completed our study. The mean (SD) of RDAS was 52.9 (9.7). RDAS score showed a significant correlation with anxiety symptoms, frequency of intercourse and quality of life (p < 0.05). Also, RDAS score was poorer in recipients with low education level, low family income and positive history of graft rejection (p < 0.05). RDAS score was not significantly associated with gender, occupation, age at transplantation time, transplant-to-rejection time interval, source of graft, cause and duration of end-stage renal disease and depression (p > 0.05). Transplantation medical teams should refer patients to psychologists and/or psychiatrists for marital satisfaction consultation before kidney transplantation. This is of great significance especially in those with older ages, lower levels of education and lower income. Marital discord may also be considered as a cause or an effect of an unsatisfactory sexual relationship, higher anxiety or lower quality of life after kidney transplantation.

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Having enjoyed considerable success in kidney transplantation in recent years, Iran has been named the most active country in the Middle East Society for Organ Transplantation region in providing equitable quick, and intermediary-free access to affordable kidney transplantation for everyone regardless of gender and economic circumstances. We are, however, of the opinion that the Iranian model can benefit further from improving deceased-donor kidney transplantation, especially after a fatwa (Islamic edict) in the early 1980s lifted many religious and legal barriers. Deceased-donor kidney transplantation in Iran should be bolstered by establishing a transplantation model, increasing government funds, and encouraging participation of the general public in the Iranian Network for Transplant Organ Procurement. We recommend that an intensive media campaign be launched to heighten public awareness and more transplantation centres be involved in cadaveric transplantation with streamlined systems of cadaveric donations registration so as to facilitate the process of finding and relating the donors with potential recipients.