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Kidney transplantation is the gold standard for patients with end- stage kidney disease (ESKD). In view of shortages of available organs, long wait times for possible transplantation and strict regulation, many patients opt for commercial transplantation. This study elicits the reasons and motivations for ESKD patients to elect for commercial transplant.A questionnaire-based evaluation was conducted during the period from July 2015 until late December 2015. It consisted of 29 multiple choice questions and was distributed to all patients who underwent commercial kidney transplantation.One hundred fifty patients were approached to participate and 106 agreed to participate. Of the participantsThe study showed that the most common underlying cause for seeking commercial transplantation is the unavailability of a national transplant program, particularly transplantation from deceased sources. All western ethical arguments turn out to become of vital importance in developing countries, because transplantation is the cheapest renal replacement therapy. However, it must be emphasized that commercial transplants should not be an alternative to building a national transplant initiative. National diseased program must be a priority with full financial and administrative support. All government agencies including religious affairs must work together to support the program to provide the citizens with a good transplantation service and ameliorate the impact of commercial transplantation.