Bridging the ‘Gap’ in Developing Countries: At what Expense?

Experts from all continents have called for the emerging countries to start chronic kidney disease prevention and screening programs, develop end-stage renal disease registries and start or further strengthen transplantation programs through International as well as regional collaborations to acquire the information, technology, experience and skills necessary whilst acknowledging these goals are ambitious (Remuzzi, Perico, et al. 2010). Transplantation is the optimal renal replacement therapy for children with end-stage renal disease. Compared with dialysis, successful transplantation in children and adolescents not only ameliorates uremic symptoms but also allows for significant improvement of delayed growth, sexual maturation, and psychosocial functioning. The child with a well-functioning kidney can enjoy a quality of life that cannot be achieved by dialysis therapy (Uchida 2010). Although renal transplantation is an excellent option for the treatment of uremic children, it is more difficult compared to adults due to different etiologies often congenital, difficult surgical technique(van Heurn and deVries 2009), size match problems of the donor kidney and the post-operative hemodynamic effects due to poorly managed chronic renal failure and its effects upon growth and development. Most importantly, the lack of expertise, financial restraints and low-level national prioritization adds to the problem and prevents the establishment of fully-fledged pediatric renal transplant programs in developing countries (Bamgboye, 2009). However, despite the negativism (Muthusethupathi & Shivakumar 1993), many medical personnel in developing countries have attempted to bridge the gap (Usta et al. 2008), often successfully and have developed pediatric kidney transplant programs (Badmus et al. 2005) (Kandus et al 2009). Doctors embarking on such programs would inevitably feel the punch as healthcare in developing countries are less funded than developed nations (0.8 to 4% vs. 10 to 15%, respectively), and must contend against approximately 1/3 of the population living below the poverty line ($1US/day), poor literacy (58% males/29% females), and less access to portable water and basic sanitation. Cultural and societal constraints combine with these economic obstacles. Donor shortage is a universal problem. Post-transplant infections are a major problem in developing countries, with 15% developing tuberculosis, 30% cytomegalovirus, and nearly 50% bacterial infections. The solutions may seem simplistic: alleviate poverty, educate the general population, and expand the transplant programs in