SAT-334 DISPARITIES IN TRANSPLANTATION ACCESS ACROSS DIFFERENT COUNTRIES: AN ISN FELLOWS COLLABORATIVE STUDY

Abstract

Kidney transplantation (KTx) is the best modality of treatment for kidney failure. Access to KTx should be available to all patients with end-stage kidney disease (ESKD). However, disparities in access to KTx exist and are more complicated in low and middle income countries. We sought to discover challenges facing these countries in providing universal access to kidney transplantation through this International society of Nephrologist (ISN) fellows collaborative review. The ISN fellows collaborative review conducted with the participation of ISN fellows from 11 countries. Countries profile including population size and density, gross national income per capita and total expenditure on health per capita, total expenditure on health and life expectancy at birth were referenced from World Health Organization (WHO) and UN online data source. Information regarding the national transplant programs, nephrology societies' database, national KTx registry data and literature search with other specific data collected from each ISN fellow and/or country representatives were described across the countries. Only three of the 11 countries have transplant registries and four of the rest are developing a registry. Except Turkey and Kazakhstan, there is no full governmental coverage for KTx. Both Cameroon and Democratic Republic of the Congo (DRC) have not initiated a kidney transplant program yet. In all countries except Cameroon and DRC, KTx from living donors is available. The most important barrier is the lack of deceased donors and lack of clear concept of brain death in most countries. High cost of KTx and the first year maintenance immunosuppressive treatment is the second important barrier for the countries considered. In almost half (5/11) of the countries, organ trafficking is still present, yet decreasing with governmental effort. Still absent are legal regulations and governmental precautions in some countries. *Barriers category: A,high rate of brain death unacceptance by relatives; B,Long waiting time; C,Insufficient Deceased donor; D,Paid unrelated live donors; E,No institutional support and legal laws; F,Lack of tissue typing; G,High cost of medicine; H,Insufficient Living& Deceaseddonor; J,Cultural/spiritual impediments; K,Low number of referrals Multiple challenges are facing LMICs countries to provide universal access for kidney transplantation to patients with ESKD. Governmental and educational awareness programs should be encouraged to increase the number of deceased donors. Transplant cost has to be reimbursed by governments to encourage KTx for patients with ESKD. The concept of brain death should be clarified, legislations for deceased donation should be adopted and strict regulations to stop organ trafficking are much needed.