title: 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.
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Dow Medical College, Karachi, Pakistan. siut-1@cyber.net.pk
authors.forename: S Adibul Hasan
authors.initials: SA
authors.lastname: Rizvi
authors.forename: S A Anwar
authors.initials: SA
authors.lastname: Naqvi
authors.forename: Zafar
authors.initials: Z
authors.lastname: Hussain
authors.forename: Altaf
authors.initials: A
authors.lastname: Hashmi
authors.forename: Fazal
authors.initials: F
authors.lastname: Akhtar
authors.forename: Manzoor
authors.initials: M
authors.lastname: Hussain
authors.forename: Ejaz
authors.initials: E
authors.lastname: Ahmed
authors.forename: M Naqi
authors.initials: MN
authors.lastname: Zafar
authors.forename: Saleem
authors.initials: S
authors.lastname: Hafiz
authors.forename: Rana
authors.initials: R
authors.lastname: Muzaffar
authors.forename: Fatema
authors.initials: F
authors.lastname: Jawad
mesh_terms: D003906:Developing Countries; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000601:surgery*; D016030:Kidney Transplantation / Q000191:economics / Q000706:statistics & numerical data*