POSITION PAPER
Transpl. Int.
Kidney Transplantation in Western Balkans: A Regional Blueprint for Access, Capacity, and Equity
- ER
Elvana Rista 1,2
- GS
Goce Spasovski 3
- DR
Damir Rebic 4
- ML
Mirjana Lausevic 5,6
- DR
Danilo Radunovic 7
- VG
Vjollca Godanci 8
- AS
Ariana Strakosha 9
- AI
Alma Idrizi 9
- KS
Kristi Saliaj 1,2
- EB
Emin Baris Akin 10
- JS
Jelena Stojanovic 11
- FO
Fernanda Ortiz 12
- CL
Carmen Lefaucheur 13
- LP
Luciano Potena 14
- EC
Efstratios Chatzixiros 15
- JA
Jamil Azzi 16
- DM
Devi Mey 17
1. European University of Tirana, Tirana, Albania
2. Hygeia Hospital Tirana, Tirana, Albania
3. University of Skopje, Sts. Cyril and Methodius, Skopje, North Macedonia
4. Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
5. Medical Faculty University of Belgrade, Belgrade, Serbia
6. University Clinical Centre of Serbia, Belgrade, Serbia
7. Clinical Center of Montenegro, Podgorica, Montenegro
8. UCCK University Clinical Centre of Kosova, Pristina, Albania
9. University Hospital Center “Mother Teresa”, Tirana, Albania
10. Demiroglu Bilim University Florence Nightingale Hospital, Istanbul, Türkiye
11. Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
12. Helsinki University Hospital, Helsinki, Finland
13. Saint Louis Hospital, Assistance Publique-Hopiteux de Paris and Université Paris Cité, Paris, France
14. IRCCS University Hospital of Bologna Sant’ Orsola Polyclinic, Bologna, Italy
15. Medicines-Health Products Policies & Standards Department, World Health Organization (WHO, Geneva, Switzerland
16. Brigham and Women’s Hospital, Harvard Medical School, Boston, United States
17. The European Society for Organ Transplantation, Amsterdam, Netherlands
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Abstract
Word count: 188 There is no medical field where the impact of medical evolution is more palpable than in kidney transplantation. The pioneers of this procedure, 70 years ago, laid out the foundation for organ transplantation in general and kidney transplantation in particular. Despite the incredible advancements that have been made since, huge differences exist worldwide in terms of access, equity and quality of care. Nowhere are these disparities more prominent than in developing countries with limited resources, underfunded healthcare systems and transplantation infrastructures, particularly the Western Balkans. This position paper delineates the biggest barriers hindering the development of kidney transplantation in the Western Balkans, put forth and agreed upon by a group of regional experts on the field, based on the Modified Delphi Method. Limitations in training, infrastructure, restrictive and outdated legislative practices, lack of a centralized coordination network and fragmented regional collaboration, emerged as the principal challenges. Endorsed by European Society for Organ Transplantation (ESOT), this paper outlines a pragmatic and practical framework to overcome these obstacles, towards building robust and sustainable transplantation programs that ensure high-quality and equitable access to kidney transplantation, for all patients in this region.
Summary
Keywords
blueprint, equity, health systems, kidney transplantation, Western Balkans
Received
25 November 2025
Accepted
30 January 2026
Copyright
© 2026 Rista, Spasovski, Rebic, Lausevic, Radunovic, Godanci, Strakosha, Idrizi, Saliaj, Akin, Stojanovic, Ortiz, Lefaucheur, Potena, Chatzixiros, Azzi and Mey. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Elvana Rista, dr.elvana@gmail.com
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.