The global role of kidney transplantation

Abstract

World Kidney Day on 8 March 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end-stage renal disease (ESRD) that surpasses dialysis treatments for the quality and quantity of life and for cost effectiveness. An experimental, risky, and very limited treatment option 50 years ago is now routine clinical practice in more than 80 countries. What was limited to a few people in a small number of academic centers is now routinely transforming lives in most high- and medium-income countries. The largest numbers of transplantations are performed in the United States, China, Brazil, and India, while the greatest population access to transplantation is in Croatia, Portugal, Spain, Austria, the United States, and Norway, but almost all countries have growing waiting lists, and transplantation meets only 10% of the global need. Barriers to broader application include, of course, economic limitations that appropriately place transplantation at a lower priority than clean water, sanitation, and vaccination. Even in high-income countries, the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major restrictions on kidney transplantation rates are the shortage of donated organs and the small size of trained medical, surgical, and nursing workforces with the required expertise.