A Renal Transplantation Model for Developing Countries

Abstract

The estimated incidence of end-stage renal disease (ESRD) in Pakistan is 100 per million population. Paucity and high costs of renal replacement therapy allows only 10% to get dialysis and 4-5% transplants. Our center, a government organization, started a dialysis and transplant program in 1980s where all services were provided free of charge to all patients. It was based on the concept of community government partnership funded by both partners. The guiding principles were equity, transparency, accountability and development of all facilities under one roof. This partnership has sustained itself for 30 years with an annual budget of $25 million in 2009. Daily 600 patients are dialyzed and weekly 10-12 receive transplants. Oneand 5-year graft survival of 3000 transplants is 92% and 85%, respectively. The institute became a focus of transplantation in Pakistan and played a vital role in the campaign against transplant tourism and in promulgation of transplant law of 2007, and also helped to increase altruistic transplants in the country. This model emphasizes that in developing countries specialized centers in government sector are necessary for transplantation to progress and community support can make it available to the common man.

Pediatric Kidney Transplantation in the Developing World: Challenges and Solutions

“…Indeed many of the apprehensions are removed when kidney donors propagate donation. We observed a fall of donation refusal rates in our earlier period of 60% compared to 15% in the present (38). This is also reflected in the increase of renal transplants performed at our center from about 100 per year in 1990s to >400 in 2009 (38).…”

“…This model of community-government partnership has sustained itself for 25 years with the funding by the two partners having increased to over $30 million (38). Annually, over 1000 patients receive 200 000 dialysis sessions and 350-550 receive transplants, 10-15% being children.…”

“…Annually, over 1000 patients receive 200 000 dialysis sessions and 350-550 receive transplants, 10-15% being children. About 40% of the patients come from other provinces of the country as far as 2000 km (38,41). To maintain this large number of patients a number of economizing strategies were introduced to reduce cost without compromising quality.…”

“…To facilitate transplanted children and ensure 100% follow-up, the medical social department provides travel costs and free accommodation to about 5-19% of the patients each year. Posttransplant immunosuppressive drugs are provided free for life and for 3 months at a time for patients living in far off places (38,41).…”

O papel global do transplante renal

“…14 In 2001, in Central America, a specialized unit of pediatric nephrology and urology was opened in Nicaragua with funds provided initially by the Associazione per il Bambino Nefropatico, a kidney foundation based in Milan, Italy, supplemented by a consortium of private and public organizations, including the International Pediatric Nephrology Association and the Nicaraguan Ministry of Health.…”