title: A kidney transplantation model in a low-resource country: an experience from Pakistan.
abstract: Pakistan is a low-resource country with a population of 185 million where expenditure on health is 1.3% of the gross national product. The estimated incidence of end-stage renal disease (ESRD) is 100 per million of the population. The paucity and high costs of renal replacement therapy render more than 90% of the ESRD population disenfranchised from replacement therapy. Our center, which is a government sector organization, established as an integrated dialysis and living related renal transplant program in the 1980s, where all services were provided free of cost to all patients with life-long follow-up care including medications. The model was based on a concept of community/government partnership where the contributions to funds vary between 40% and 60% for each partner. The model has been self sustaining for 25 years, with an annual budget of $28 million in 2010. Presently, over 600 patients are dialyzed each day and each week, 7-10 patients have received live related transplants. The overall 1- and 5-year graft survival rate of 3150 transplants is 92% and 85%, respectively. Free dialysis and transplantation established our institute as a focus of transplantation in the country. This model therefore allowed the institute to have a vital role in the campaign against transplant tourism and in the promulgation of the transplant law. It shows that in low-resource countries, specialized centers in the government sector can, with community support, provide high-quality ESRD care to the disenfranchised population.
authors.affiliation: Department of Urology and Transplant Surgery, Sindh Institute of Urology and Transplantation , Karachi, Pakistan.
authors.forename: Syed Adibul Hasan
authors.initials: SA
authors.lastname: Rizvi
authors.affiliation: Department of Urology and Transplant Surgery, Sindh Institute of Urology and Transplantation , Karachi, Pakistan.
authors.forename: Syed Ali Anwar
authors.initials: SA
authors.lastname: Naqvi
authors.affiliation: Department of Pathology, Sindh Institute of Urology and Transplantation , Karachi, Pakistan.
authors.forename: Mirza Naqi
authors.initials: MN
authors.lastname: Zafar
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation , Karachi, Pakistan.
authors.forename: Syed Fazal
authors.initials: SF
authors.lastname: Akhtar
keywords: developing country; model; transplant