Egypt is a developing country and despite significant advances in chronic hemodialysis services, renal transplantation in children is lagging tremendously behind. The aim of this study was to assess the difficulties against renal transplantation in Egyptian children and the attitudes of the families of these children towards such a treatment option. The study included 53 children and young adults (27 males and 26 females) with an age range of 5–22 years (mean 13.5). All children were attending regular hemodialysis services at the Paediatric Nephrology Units of Cairo and Ain Shams Universities. The families and children were interviewed and their records analyzed. Most families were of low socioeconomic status. Only 5 children (9 %) were able to go to school regularly or had obtained any school certificates. Most parents were illiterate (70 % of fathers and 85 % of mothers). 16 children (30 %) reported depression of varying degrees. Causes for their end stage renal disease included lupus nephritis in 6 (11 %), reflux nephropathy in 5 (9 %), stone disease in 3 (5.5 %), F S G S in 3 (5.5 %), various congenital anomalies of the urinary tract in 8 (15 %) and 28 (54 %) had an unknown aetiology. The total duration on hemodialysis ranged from 1 month to 12 years (mean 25 months). 47 children (89 %) required 3 hours per session, three times weekly, 4 required 4 hours and 2 required 2 hours on average per session. There are no long term peritoneal dialysis services in Egypt. Only 27 families (51 %) reported having discussed renal transplantation with any medical professional prior to this interview. 25 families (47 %) stated a living related donor was ready if transplantation was possible. This donor was the mother in 12 cases, a sibling in 5 cases, the father in 2, either the mother or father in 5, and another distant relative in one case. One family only refused the idea of a living non-related donor and 3 families refused cadaveric transplantation in principle, due to religious beliefs (cadaveric transplantation is not permitted by law in Egypt). Only seven families (13 %) stated they had enough money (or were able to collect it) to purchase a kidney from a living non-related donor. Thirty one families (58 %) had no idea the government health insurance services can cover the cost of the surgery and immunosuppression therapy, provided there is a suitable donor. There are many difficulties against a successful renal transplantation program for children with end stage renal disease in Egypt. The government and health authorities must address such issues and offer effective assistance to such families to increase awareness and facilitate such a treatment option.