Abstract:Kidney transplantation remains the preferred treatment for end-stage kidney disease (ESKD). Several large registry-based studies comparing transplanted versus waitlisted patients have demonstrated that kidney
“…Transplantation has significant medico-legal implications requiring robust legal framework. This should cover organ donation legitimacy, regulatory bodies, criteria and processes of accreditation, certification and standardization of transplant centres [98]. Transplantation programmes afford SSA opportunities to learn and adapt legislation from other regions.…”
Section: Comprehensive Legislation and Regulationmentioning
Sub-Saharan Africa (SSA), occupying about 80% of the African continent is a heterogeneous region with estimated population of 1.1 billion people in 47 countries. Most belong to the low resource countries (LRCs). The high prevalence of end-organ diseases of kidney, liver, lung and heart makes provision of organ donation and transplantation necessary. Although kidney and heart transplantations were performed in South Africa in the 1960s, transplant activity in SSA lags behind the developed world. Peculiar challenges militating against successful development of transplant programmes include high cost of treatment, low GDP of most countries, inadequate infrastructural and institutional support, absence of subsidy, poor knowledge of the disease condition, poor accessibility to health-care facilities, religious and trado-cultural practices. Many people in the region patronize alternative healthcare as first choice. Opportunities that if harnessed may alter the unfavorable landscape are: implementation of the 2007 WHO Regional Consultation recommendations for establishment of national legal framework and self-sufficient organ donation/transplantation in each country and adoption of their 2020 proposed actions for organ/transplantation for member states, national registries with sharing of data with GODT, prevention of transplant commercialization and tourism. Additionally, adapting some aspects of proven successful models in LRCs will improve transplantation programmes in SSA.
“…Transplantation has significant medico-legal implications requiring robust legal framework. This should cover organ donation legitimacy, regulatory bodies, criteria and processes of accreditation, certification and standardization of transplant centres [98]. Transplantation programmes afford SSA opportunities to learn and adapt legislation from other regions.…”
Section: Comprehensive Legislation and Regulationmentioning
Sub-Saharan Africa (SSA), occupying about 80% of the African continent is a heterogeneous region with estimated population of 1.1 billion people in 47 countries. Most belong to the low resource countries (LRCs). The high prevalence of end-organ diseases of kidney, liver, lung and heart makes provision of organ donation and transplantation necessary. Although kidney and heart transplantations were performed in South Africa in the 1960s, transplant activity in SSA lags behind the developed world. Peculiar challenges militating against successful development of transplant programmes include high cost of treatment, low GDP of most countries, inadequate infrastructural and institutional support, absence of subsidy, poor knowledge of the disease condition, poor accessibility to health-care facilities, religious and trado-cultural practices. Many people in the region patronize alternative healthcare as first choice. Opportunities that if harnessed may alter the unfavorable landscape are: implementation of the 2007 WHO Regional Consultation recommendations for establishment of national legal framework and self-sufficient organ donation/transplantation in each country and adoption of their 2020 proposed actions for organ/transplantation for member states, national registries with sharing of data with GODT, prevention of transplant commercialization and tourism. Additionally, adapting some aspects of proven successful models in LRCs will improve transplantation programmes in SSA.
“…To facilitate better preparation for and to maximise sustainability of kidney replacement therapies in areas with resource-limited regions, the International Society of Nephrology (ISN) is developing guidance documents applicable to both adults and children for the World Health Organisation. A recent review addresses the various components involved in incorporating transplantation within integrated care for kidney care [ 33 ]. From a national level perspective, the key areas governing sustainable transplant services include legislation, regulation, health finance, health workforce, family and community involvement, maintenance of registries, strengthening deceased organ transplant programs and abiding by ethical standards.…”
“… Fig. 2 Essential components of a sustainable paediatric transplant program at various levels of health care relevant to LLMIC based on reference 33 . *Universal health coverage …”
Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.
“…Proposed activities included data capture, policy creation, definition of quality standards, evidence-based guidance, capacitybuilding, implementation, and research, as well as a performance measurement framework to assess progress. [3][4][5][6][7][8][9][10][11][12][13] In parallel, the ISN is working with the World Health Organization (WHO) to develop a technical package for those wishing to start or expand dialysis services.…”
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