A kidney transplantation model in a low-resource country: an experience from Pakistan

Abstract

Pakistan is a low-resource country with a population of 185 million where expenditure on health is 1.3% of the gross national product. The estimated incidence of end-stage renal disease (ESRD) is 100 per million of the population. The paucity and high costs of renal replacement therapy render more than 90% of the ESRD population disenfranchised from replacement therapy. Our center, which is a government sector organization, established as an integrated dialysis and living related renal transplant program in the 1980s, where all services were provided free of cost to all patients with life-long follow-up care including medications. The model was based on a concept of community/government partnership where the contributions to funds vary between 40% and 60% for each partner. The model has been self sustaining for 25 years, with an annual budget of $28 million in 2010. Presently, over 600 patients are dialyzed each day and each week, 7–10 patients have received live related transplants. The overall 1- and 5-year graft survival rate of 3150 transplants is 92% and 85%, respectively. Free dialysis and transplantation established our institute as a focus of transplantation in the country. This model therefore allowed the institute to have a vital role in the campaign against transplant tourism and in the promulgation of the transplant law. It shows that in low-resource countries, specialized centers in the government sector can, with community support, provide high-quality ESRD care to the disenfranchised population.

Living Donor Nephrectomy at the National Kidney and Transplant Institute: Surgical Techniques, Perioperative Complications and Outcomes

“…In this study, majority of the living kidney donors were male which is similar to other Asian countries such as Iran, Korea, Pakistan and Saudi Arabia [9][10][11][12]. However, in other countries such as USA, Singapore, Germany and Amsterdam, majority were female donors [13][14][15][16].…”

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“…In Pakistan, at the Sind Institute of Urology and Transplantation (SIUT), a medical institution founded by Dr. Adib Rizvi, ethical livingdonor kidney transplant was provided free-of-cost for all patients. 18 By the end of 2013, a total of 4140 kidney transplants were performed in SIUT including 392 kidney transplants (2.3 pmp) in 2013. Similar transplant activity also was performed by other transplant teams.…”

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“…Long distances have been also found to affect compliance rates in other studies. [20][21][22] Travel is also associated with increased risk of bacterial infection, anemia, and inflammatory response. 20 To tackle this problem, SIUT has established 7 satellite centers for dialysis in recent years: 4 in the same city of Karachi and 3 in other cities including 1 in Azad Kashmir.…”

“…This step will help provide renal care facilities to all near their home town and in turn may improve compliance with treatment. [20][21][22] Socioeconomic factors are also important in affecting the quality of life of hemodialysis patients and their compliance. [17][18][19]23 Most of our patients belong to low socioeconomic groups, and lack of family was found to contribute to noncompliance in around 15% of patients in this study.…”