Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience

Ackoundou-N’Guessan, Clément; Hoang, Anh Dung; Abdallah, T. Ben; Gnionsahe, D.A.; Dollo, I.; Ripoche, C.; Coulibaly, N.; Aye, D; N’guessan, Francis Yapi; Kouamé, B.; Guei, Cyr Monley; Tia, Mélanie Weu; Amekoudji, Y.; Lagou, D.A.

doi:10.1016/j.transproceed.2015.03.053

Cited by 8 publications

(7 citation statements)

References 10 publications

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“…Strategies for addressing these important gaps in kidney care include creation of national health insurance schemes; public education regarding organ donation; local health professional training in kidney transplantation; procurement of low-cost immunosuppressive agents and therapeutic drug monitoring; and facilitation of partnerships among government, industry, and nongovernment and philanthropic organizations to promote kidney transplantataion. 39 Funding structures for RRT also showed considerable variations between countries and regions. While just over one-half of countries publicly funded RRT with or without a patient copayment, this was much less common in low-and lower middle-income countries and countries in the African, South Asian, and OSEA regions where there was a large private contribution toward payment for RRT services.…”

Section: Discussionmentioning

confidence: 99%

Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

Htay

Alrukhaimi

Ashuntantang

et al. 2018

Kidney International Supplements

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Section: Discussionmentioning

confidence: 99%

Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

Htay

Alrukhaimi

Ashuntantang

et al. 2018

Kidney International Supplements

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“…Only 6 studies [10, 20, 22, 24, 26, 36] specified the surgical approaches used. Overall, open nephrectomy accounted for 95%.…”

Section: Resultsmentioning

confidence: 99%

A Scoping Review of Kidney Transplantation in Africa: How Far have We Come?

Davis,

Zubair,

Igbokwe

et al. 2023

World j. surg.

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Introduction Kidney transplantation is a life‐saving treatment for end‐stage kidney disease (ESKD) patients. However, access to this treatment in Africa lags behind other regions, leading to significant disparities in care. We aimed to analyse the indications, demographics, and outcomes of kidney transplantation in Africa. Method We conducted a systematic review of studies from PubMed, Google Scholar, and African Journal Online using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We pooled and analysed data on procedure type, graft outcomes, donor type, prophylaxis, post‐operative complications, and survival from 33 eligible studies. Result The most common causes of ESKD requiring transplantation were glomerulonephritis and nephroangiosclerosis. Open nephrectomy was the predominant surgical approach (95%). Living donors accounted for 56.3% (4221) of all donors, with 68.5% being related to the recipient. Cadaveric donors accounted for 43.7% (3280) of transplants. Graft rejection was the most common surgical complication (39.44%), and 60.49% of patients developed hypertension in the follow‐up period. Conclusion Our study highlights the potential of kidney transplantation to improve the lives of ESKD patients in Africa. However, further research and infrastructure development are necessary to make this treatment more widespread and successful.

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“…However, in settings such as SSA, not giving priority to the family member with income will devastate whole families, and should be avoided if other concerns, like financial risk protection, are prioritized. Families themselves often make this decision before seeking care, which may contribute to the greater proportion of men being treated for ESKF in SSA [ 47 – 49 ].…”

Section: Discussionmentioning

confidence: 99%

Bedside rationing and moral distress in nephrologists in sub- Saharan Africa

2022

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Background Kidney diseases constitute an important proportion of the non-communicable disease (NCD) burden in Sub-Saharan Africa (SSA), though prevention, diagnosis and treatment of kidney diseases are less prioritized in public health budgets than other high-burden NCDs. Dialysis is not considered cost-effective, and for those patients accessing the limited service available, high out-of-pocket expenses are common and few continue care over time. This study assessed challenges faced by nephrologists in SSA who manage patients needing dialysis. The specific focus was to investigate if and how physicians respond to bedside rationing situations. Methods A survey was conducted among a randomly selected group of nephrologists from SSA. The questionnaire was based on a previously validated survey instrument. A descriptive and narrative approach was used for analysis. Results Among 40 respondents, the majority saw patients weekly with acute kidney injury (AKI) or end-stage kidney failure (ESKF) in need of dialysis whom they could not dialyze. When dialysis was provided, clinical compromises were common, and 66% of nephrologists reported lack of basic diagnostics and medication and > 80% reported high out-of-pocket expenses for patients. Several patient-, disease- and institutional factors influenced who got access to dialysis. Patients’ financial constraints and poor chances of survival limited the likelihood of receiving dialysis (reported by 79 and 78% of nephrologists respectively), while a patient’s being the family bread-winner increased the likelihood (reported by 56%). Patient and institutional constraints resulted in most nephrologists (88%) frequently having to make difficult choices, sometimes having to choose between patients. Few reported existence of priority setting guidelines. Most nephrologists (74%) always, often or sometimes felt burdened by ethical dilemmas and worried about patients out of hospital hours. As a consequence, almost 46% of nephrologists reported frequently regretting their choice of profession and 26% had considered leaving the country. Conclusion Nephrologists in SSA face harsh priority setting at the bedside without available guidance. The moral distress is high. While publicly funded dialysis treatment might not be prioritized in essential health care packages on the path to universal health coverage, the suffering of the patients, families and the providers must be acknowledged and addressed to increase fairness in these decisions.

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Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience

Cited by 8 publications

References 10 publications

Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

A Scoping Review of Kidney Transplantation in Africa: How Far have We Come?

Bedside rationing and moral distress in nephrologists in sub- Saharan Africa

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