Renal transplantation in developing countries

Abstract

Healthcare in developing countries less funded than developed nations (0.8 to 4% vs. 10 to 15%, respectively), and must contend against approximately 1/3 of the population living below the poverty line ($1US/day), poor literacy (58% males/29% females), and less access to potable water and basic sanitation. Cultural and societal constraints combine with these economic obstacles to translate into poor transplantation activity. Donor shortage is a universal problem. Paid donation comprises 50% of all transplants in Pakistan. Post-transplant infections are a major problem in developing countries, with 15% developing tuberculosis, 30% cytomegalovirus, and nearly 50% bacterial infections. The solutions to these problems may seem simplistic: alleviate poverty, educate the general population, and expand the transplant programs in public sector hospitals where commerce is less likely to play a major role. The SIUT model of funding in a community-government partnership has increased the number of transplantations and patient and organ survival substantially. Over the last 15 years, it has operated by complete financial transparency, public audit and accountability. The scheme has proven effective and currently 110 transplants/year are performed, with free after care and immunosuppressive drugs. Confidence has been built in the community, with strong donations of money, equipment and medicines. We believe this model could be sustained in other developing nations.

Incidência e fatores de risco para complicações infecciosas no primeiro ano após o transplante renal

“…On the other hand, advances in diagnosis and treatment, in addition to better professional qualification, have determined a progressive reduction in the prevalence of infectious episodes in recent years. 1,[4][5][6] This study was carried out aiming at establishing the incidence of infectious complications and their risk factors after renal transplantation performed at our institution, and at comparing them with the results obtained at other centers.…”

Basiliximab as Induction in Kidney Transplantation: Are There any Real-Life Advantages?

“…About 80% of the world population resides in developing world who owns only about 25% of the total wealth and only 0.8 to 4% of fund is used in healthcare sector in comparison to 10 to 15% in developed countries. 11 Bangladesh is a developing country of South-Asia, with a population burden of 160 million (approx.). Nephrology is relatively a juvenile branch of medical science in our country.…”

Key issues in transplant tourism

“…It is important that accurate data on outcomes of transplants carried out abroad are known so that patients can be counselled about such activity [24,42] . The outcome of recipients of organs through TT is reported to be inferior to those transplanted under ethically more acceptable conditions (Table 2) [5,6,23,25,[41][42][43][44][45][46][47][48][49][50][51][52][53][54] .…”

“…Transplants performed in less than ideal circumstances are characterised by inadequate pretransplant evaluation, general lack of information about peri-operative issues, immunosuppression and long term outcome. Despite these factors, there are numerous reports indicating that TT is associated with a high incidence of surgical complications, acute rejection and invasive infection which cause major morbidity and mortality [5,23,25,29,43,44,46,49,50,51,[55][56][57][58] .…”