Abstract

BackgroundAccess to kidney transplantation is limited to more than half of the Mexican population.A fragmented health system, gender, and sociocultural factors are barriers to transplant care. We analyzed kidney transplantation in Mexico and describe how public policies and sociocultural factors result in these inequities.MethodsKidney transplant data between 2007 to 2019 were obtained from the National Transplant Center database. Transplant rates and time spent on the waiting list, by age, gender, health system, and insurance status, were estimated.ResultsDuring the study period 34,931 transplants were performed. Recipients median age was 29 (IQR 22–42) years, 62.4% were males, and 73.9% were insured. 72.7% transplants were from living-donors. Annual transplant rates increased from 18.9 per million population (pmp) to 23.3 pmp. However, the transplant rate among the uninsured population remained low, at 9.3 transplants pmp. In 2019, 15,890 patients were in the waiting list; 60.6% were males and 88% were insured. Waiting time to transplant was 1.55 (IQR 0.56–3.14) years and it was shorter for patients listed in the Ministry of Health and private facilities, where wait lists are smaller, and for males. Deceased-organ donation rates increased modestly from 2.5 pmp to 3.9 pmp.ConclusionsIn conclusion, access to kidney transplantation in Mexico is unequal and restricted to patients with medical insurance. An inefficient organ procurement program results in low rates of deceased-donor kidneys. The implementation of a comprehensive kidney care program, recognizing kidney transplantation as the therapy of choice for renal failure, offers an opportunity to correct these inequalities.

Highlights

  • Access to kidney transplantation is limited to more than half of the Mexican population

  • The largest proportion (73.9%) of transplant recipients were patients with health care insurance, and over half of all transplants were performed at the Mexican Institute of Social Security (IMSS by its Spanish acronym), the largest dialysis and kidney transplant provider in Mexico (Table 1)

  • Access to health care insurance in Mexico has been a constitutional right since 1983 [3], patients without social security must bear the cost of transplant surgery, including the expenses incurred in living-donor and deceased-donor organ retrieval, as well as the cost of maintaining the immunosuppressive therapy [7]; as a result transplantation rates remained significantly lower among the uninsured population (9.3 pmp vs. 41.7 pmp) in comparison with patients with health care insurance

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Summary

Methods

Kidney transplant data between 2007 to 2019 were obtained from the National Transplant Center database. Transplant rates and time spent on the waiting list, by age, gender, health system, and insurance status, were estimated. Kidney transplant data from 2007 to 2019 were obtained from the National Transplant Center’s (CENATRA by its Spanish acronym) kidney wait list file [12], kidney transplant files [13], and organ and tissue donor files [14]. Gender, health system of transplant, insurance status, date of transplant; date of placement in the waiting list (deceased-donor only), time spent on the waiting list until transplanted, state where the transplant was performed; donor type (deceased, living-related, living-unrelated), health system where deceased-donor kidneys were retrieved, and state of organ procurement were recorded. Due to the lack of a national dialysis registry, time spent on the waiting list was estimated from the date of listing to the date of transplant. Statistical analysis was done using the SPSS software, version 21.0 ((SPSS Inc., Chicago IL)

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Conclusion

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