The global role of kidney transplantation

There remain major challenges to providing optimal treatment for ESRD worldwide and a need, particularly in lowincome economies, to mandate more focus on community screening and implementation of simple measures to minimize progression of CKD. The recent designation of renal disease as an important non-communicable disease at the UN High Level Meeting on non-communicable diseases is one step in this direction.31 But early detection and prevention programs will never prevent ESRD in everyone with CKD, and kidney transplantation is an essential, viable, costeffective and life-saving therapy that should be equally available to all people in need. It may be the only tenable long-term treatment option for ESRD in low-income countries because it is both cheaper and provides a better outcome for patients than other treatment for ESRD. However, the success of transplantation has not been delivered evenlyacross the world, and substantial disparities still exist in access to transplantation, we remain troubled by commercialization of living donor transplantation and exploitation of vulnerable populations for profit. There are solutions available. These include demonstrably successful models of kidney transplant programs in many developing countries; growing availability of less expensive generic immunosuppressive agents; improved clinical training opportunities; governmental and professional guidelines legislating prohibition of commercialization and defining professional standards of ethical practice; and a framework for each nation to develop self-sufficiency in organ transplantation through focus on both living donation and especially nationally managed deceased organ donation programs. The ISN and TTS have pledged to work together in coordinated joint global outreach programs to help establish and grow appropriate kidney transplant programs in lowand middle-income countries utilizing their considerable joint expertise. World Kidney Day 2012 provides a focus to help spread this message to governments, all health authorities and communities across the world. © 2011 Asian Pacific Society of Nephrology