Critical Need: Despite Rising End-Stage Disease, Asia’s Kidney Transplant Rate Remains Low

The incidence of end-stage kidney disease (ESKD) is growing in Asia, which has one of the highest rates in the world. While kidney transplantation is considered the preferred treatment for ESKD due to its long-term survival benefits and cost-effectiveness, statistics reveal that Asian countries have been slow to adopt this approach. In 2018, the global deceased donor median rate was 15.1 per million population (pmp), while East and North Asia, Southeast Asia (including Oceania), and West Asia reported significantly lower rates of 3.4pmp, 6.1pmp, and 4.4pmp respectively.

To address this issue, an international team of researchers, including clinicians from various Asian countries, published a paper in The Lancet Regional Health – South-east Asia. The study focused on current deceased donor kidney transplantation (DDKT) policies and practices in Asia and proposed strategies to tackle the challenges hindering its implementation. The researchers highlighted the need for a regional policy complemented by support systems, particularly in lower-income countries lacking national policies governing kidney transplantation. This absence of policies across Asia could contribute to the growth of illegal commercialized transplantation and exploitation of vulnerable communities for organ donation.

According to Dr. Jackson Tan, the lead author and consultant nephrologist at the Ministry of Health in Brunei, success in Asian DDKT programs will depend on strengthening local infrastructure, improving public engagement, coordinating multilateral support, and establishing legislative jurisdictions. The paper emphasized the unique demographics and heterogeneity of Asian societies, which require specific programs and solutions distinct from those implemented in Western countries. Additionally, disparities in population, geographical size, income status, and healthcare funding mechanisms in the region further pose challenges to increasing DDKT rates. Consequently, a regional approach is essential to achieve equitable and sustainable DDKT through increased donation, improved education, infrastructure development, international collaboration, and ethical practices.

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