The role of kidney transplantation as a component of integrated care for chronic kidney disease

Abstract

Kidney transplant provides superior outcomes to dialysis as a treatment for end-stage kidney disease. Therefore, it is essential that kidney transplantation be part of an integrated treatment and management plan for chronic kidney disease (CKD). Developing an effective national program of transplantation is challenging because of the requirement for kidney donors and the need for a multidisciplinary team to provide expert care for both donors and recipients. This article outlines the steps necessary to establish a national kidney transplant program, starting with the requirement for effective legislation that provides the legal framework for transplantation whilst protecting organ donors, their families, recipients, and staff and is an essential requirement to combat organ trafficking. The next steps involve capacity building with the development of a multiskilled workforce, the credentialing of transplant centers, and the reporting of outcomes through national or regional registries. Although it is accepted that most transplant programs will begin with living related kidney donation, it is essential to aspire to and develop a deceased donor program. This requires engagement with multiple stakeholders, especially the patients, the general community, intensivists, and health departments. Development of transplant centers should be undertaken in concert with the development of a dialysis program. Both are essential components of integrated care for CKD and both should be viewed as part of the World Health Organization's initiative for universal health coverage. Provisions to cover the costs of treatment for patients need to be developed taking into account the state of development of the overall health framework in each country.

Keywords: chronic kidney disease; integrated care; kidney transplantation; sustainable care; universal health care.

Figure 1

Global kidney transplant activity from the World Health Organization (WHO)–Spanish Transplant Organization (ONT) Global Observatory on Donation and Transplantation (GODT). Data are provided by national health authorities in WHO member states whenever transplantation (Tx) programs do exist. The figure is based on the aggregate data reported by 100 member states between 2011 and 2016, based on the GODT data, produced by the WHO-ONT collaboration (see Global Observatory on Donation and Transplantation. Organ Donation and Transplantation Activities. 2016. Available at: http://www.transplant-observatory.org/2016-activity-data/. Accessed November 18, 2018.³).

Figure 2

The number of reported deceased and live donor (LD) transplants in 2016 from each of the World Health Organization (WHO) regions. Data are provided by national health authorities in WHO member states whenever transplantation (tx) programs do exist. Rates are estimated using the regional population as the denominator. Data are based on the Global Observatory on Donation and Transplantation (GODT) data, produced by the WHO-ONT collaboration (see Global Observatory on Donation and Transplantation. Organ Donation and Transplantation Activities. 2016. Available at: http://www.transplant-observatory.org/2016-activity-data/. Accessed November 18, 2018.³). AFR, African Region; AMR, Americas Region; DD, deceased donors; EMR, Eastern-Mediterranean Region; EUR, European Region; ONT, Spanish Transplant Organization; pmp, per million population; SEAR, South-East-Asia Region; WPR, Western-Pacific Region.

Figure 3

An outline of a management plan for end-stage kidney disease (ESKD) that incorporates both dialysis and transplantation.