World Kidney Day 2012: the global role of kidney transplantation.

There remain major challenges to providing optimal treatment for ESRD worldwide and a need, particularly in low-income economies, to mandate more focus on community screening and implementation of simple measures to minimize progression of chronic kidney disease. The recent designation of renal disease as an important noncommunicable disease at the United Nations High Level Meeting on Noncommunicable Diseases is one step in this direction.(32) But early detection and prevention programs will never prevent ESRD in everyone with chronic kidney disease, and kidney transplantation is an essential, viable, cost-effective, and life-saving therapy which should be equally available to all people in need. It may be the only tenable long-term treatment option for ESRD in low-income countries since it is both cheaper and provides a better outcome for patients than other treatment for ESRD. However, the success of transplantation has not been delivered evenly across the world and substantial disparities still exist in access to transplantation.We remain troubled by commercialization of living donor transplantation and exploitation of vulnerable populations for profit. There are solutions available. These include demonstrably successful models of kidney transplant programs in many developing countries; growing availability of less-expensive generic immunosuppressive agents; improved clinical training opportunities; governmental and professional guidelines legislating prohibition of commercialization and defining professional standards of ethical practice; and a framework for each nation to develop self-sufficiency in organ transplantation through focus on both living donation and especially nationally managed deceased organ donation programs. The Transplantation Society and the ISN have pledged to work together in coordinated joint global outreach programs to help establish and grow appropriate kidney transplant programs in low- and middle-income countries utilizing their considerable joint expertise. World Kidney Day 2012 provides a focus to help spread this message to governments, all health authorities and communities across the world.