BackgroundChronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT.MethodsThe article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings.ResultsIn the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information.ConclusionsExamining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

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Viviendo con trasplante renal, sin protección social en salud: ¿Qué dicen los enfermos sobre las dificultades económicas que enfrentan y sus efectos?Kidney transplant patients without social protection in health: what do patients say about the economic hardships and impact?Viver com transplante renal sem proteção social em saúde: o que os pacientes dizem sobre as dificuldades econômicas e os seus efeitos?

aBstract:The purpose of this study was to review the empirical studies on health personnel's views towards organ donation and transplantation. A scoping review was carried out in English, Portuguese and Spanish. The search was conducted in eight databases, and two search engines. Four groups of descriptors were used. The period covered was 1985 to 2013. Frequency and content analysis was performed. Two hundred forty-eight articles were selected, out of 316 identified. The literature is temporally and geographically clustered. Quantitative studies predominate. The studies prioritized the perspective of medical and nursing personnel over other actors, such as directors and organ donation coordinators. Health personnel's attitudes toward deceased organ donation was the most examined topic. In conclusion, a growing quantitative literature analyzes the perspective of physicians and nurses with regard to deceased organ donation and transplantation. la VisiÓn del personal de salud soBre la donaciÓn Y el trasplante de Órganos: una reVisiÓn de la literatura resuMen: El objetivo de este estudio fue revisar los estudios empíricos sobre la visión del personal de salud respecto a la donación y trasplante de órganos. Se hizo una revisión panorámica de la literatura en español, inglés y portugués; realizándose la búsqueda en dos buscadores y ocho bases de datos. El periodo abarca de 1985 al 2013. Se hizo análisis de contenido y frecuencias. De 316 artículos identificados, 248 fueron seleccionados. Según los hallazgos, los trabajos se concentraron en términos temporales y espaciales; predominando aquellos con metodologías cuantitativas. Las publicaciones priorizaron la perspectiva del personal médico y enfermería sobre las de otros actores, como directivos y coordinadores de donación. Las actitudes del personal sanitario hacia la donación de órganos de fallecido fue el tema más estudiado. Se concluye que una producción creciente de tipo cuantitativo analiza la perspectiva de médicos y enfermeras sobre la donación y trasplante de órganos de fallecido.descriptores: Donación de órganos. Trasplante de órganos. Personal de salud. Actitudes. Revisión.