Gadelkareem RA, Abdelgawad AM, Mohammed N, Zarzour MA, Khalil M, Reda A, Hammouda HM. Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies? World J Methodol 2024; 14(2): 91626 [PMID: 38983660 DOI: 10.5662/wjm.v14.i2.91626]
Corresponding Author of This Article
Rabea Ahmed Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. dr.rabeagad@yahoo.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. Jun 20, 2024; 14(2): 91626 Published online Jun 20, 2024. doi: 10.5662/wjm.v14.i2.91626
Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies?
Rabea Ahmed Gadelkareem, Amr Mostafa Abdelgawad, Nasreldin Mohammed, Mohammed Ali Zarzour, Mahmoud Khalil, Ahmed Reda, Hisham Mokhtar Hammouda
Rabea Ahmed Gadelkareem, Amr Mostafa Abdelgawad, Nasreldin Mohammed, Mohammed Ali Zarzour, Mahmoud Khalil, Ahmed Reda, Hisham Mokhtar Hammouda, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Author contributions: Gadelkareem RA, Abdelgawad AM, and Mohammed N designed the research, collected the data, and wrote the paper; Reda A and Zarzour MA contributed to the literature review, stratification of the data, writing, and revision, and Hammouda HM and Khalil M contributed to the literature review, writing, revision and supervision of the work; All authors approved the paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rabea Ahmed Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. dr.rabeagad@yahoo.com
Received: January 2, 2024 Revised: January 31, 2024 Accepted: March 12, 2024 Published online: June 20, 2024 Processing time: 163 Days and 12.9 Hours
Abstract
Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.
Core Tip: Kidney transplantation (KT) programs in developing countries are confronted with major financial, sociocultural, regulatory, and political challenges. These challenges result in the delayed establishment or absence of efficient KT programs in most developing countries. They warrant finding different mechanisms to oppose these effects. Maximizing the available resources is mandatory, as represented by investing in living donors and interested medical personnel. In addition, recruiting external resources may be implemented by performing agreements with international academic institutes with expertise in KT and charitable organizations or personnel for practical and financial support.
