AUTHOR=Zafar Mirza Naqi , Rizvi Syed Adibul Hasan 

TITLE=Providing “Free” Access to Dialysis and Transplant to the Disfranchised. A Sustainable Model for Low and Low Middle Income Countries (LMICs)

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11290

DOI=10.3389/ti.2023.11290

ISSN=1432-2277

ABSTRACT=Pakistan is a low-middle-income country where incidence of End-Stage Kidney Disease (ESKD) is 100-150pmp. Paucity and high costs of renal replacement therapy (RRT) renders majority disfranchised since dialysis rate is 15pmp and transplant 4-5pmp. In view of this, our center started integrated dialysis and transplant program where all treatment is provided “Free of Cost” to all patients with lifelong follow-up with medications. The model is based on the concept of community-government-partnership funded by both partners. The annual contribution in 2021 was $37.4 million. Daily >1500 patients are dialyzed and weekly 6-8 receive transplants. Of the 6553 transplant performed between 1985-2021, 988(15%) were children. Overall 1 and 5-year graft survival rate is 97% and 88%. Donor clinic has 3786 donors in regular yearly follow-up for upto 30-35 years where ESKD prevalence is 0.29%.  Access to dialysis was increased by establishing 6 satellite centers reducing patient time and travel costs. Cost reductions by dialyzer reuse and generic drugs resulted in annual saving of $5.8m. This sustainable model has overcome the inherent socio-economic, logistic, cultural, and gender biases in RRT in LMICs. It has provided RRT with equity to the disfranchised in Pakistan and can be replicated in other LMICs with community-government support.