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Transplantation


the universality of the problems that arise from organ transplant commercialisation. The restriction of transplantation to Iranian nationals only under this programme has, however, largely ensured that this national experiment has not flowed on to create commercial organ trafficking across Iranian national borders.


The TTS and the ISN have taken a joint stand against the despoiling of transplantation therapy and victimisation of the poor and vulnerable by doctors and other providers operating in these illegal programmes. In 2008, more than 150 representatives from across the world and from different disciplines of healthcare, national policy development, law and ethics came together in Istanbul, Turkey, to discuss and define professional principles and standards for organ transplantation. The resultant Declaration of Istanbul29


has now been


endorsed by more than 110 professional and governmental organisations and implemented by many of these organisations, with the goals of eliminating transplant tourism and enhancing the ethical practice of transplantation worldwide.30


Summary


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 on the implementation of simple measures to minimise progression of CKD. The recent designation, at the UN High Level Meeting on Non-communicable Diseases, of renal disease as an importantnon-communicable disease is one step in this direction.31


1. Murray JE, Ronald Lee Herrick Memorial: June 15, 1931- December 27, 2010, Am J Transplant, 2011;11(3):419.


2. ANZDATA Registry 2010 Report on transplantation. Available at: www.anzdata.org.au/anzdata/AnzdataReport/33rdReport/ Ch08.pdf (accessed 24 February 2012).


3. Shimmura H, Tanabe K, Ishida H, et al., Lack of correlation between results of ABO-incompatible living kidney transplantation and anti-ABO blood type antibody titers under our current immunosuppression, Transplantation, 2005;80(7):985–8.


4. Peng A, Vo A, Jordan SC, Transplantation of the highly human leukocyte antigen-sensitized patient: long-term outcomes and future directions, Transplant Rev, 2006;20:146–56.


5. Warren DS, Montgomery RA, Incompatible kidney transplantation: lessons from a decade of desensitization and paired kidney exchange, Immunol Res, 2010;47(1–3):257–64.


6. Weber CLC, Rush DN, Jeffery JR, et al., Kidney transplantation outcomes in Canadian aboriginals, Am J Transplant, 2006;6:1875–81.


7. Gordon EJ, Ladner DP, Caicedo JC, Franklin J, Disparities in kidney transplant outcomes: a review, Semin Nephrol, 2010;30(1):81–9.


8. Collins JF, Kidney disease in Maori and Pacific people in New Zealand, Clin Nephrol, 2010;74(Suppl. 1):S61–5.


9. Rizvi SAH, Naqvi SAA, Zafar MN, et al., Living related renal transplants with lifelong follow-up. A model for the developing world, Clin Nephrol, 2010;74(Suppl. 1):S142–9.


10. Monteón FJ, Gómez B, Valdespino C, et al., The kidney transplant experience at Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Guadalajara México, Clin Transpl, 2003;165–74.


11. Jha V, Current status of end-stage disease care in South Asia, Ethn Dis, 2009;19(Suppl. 1):S27–32.


12. Wolfe RA, Ashby VB, Milford EL, et al., Comparison of


However, early detection and prevention programmes will never prevent ESRD in everyone with CKD, and kidney transplantation is an essential, viable, cost-effective and life-saving therapy that 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 treatments for ESRD. However, the success of transplantation has not been delivered evenly worldwide and substantial disparities still exist in the access to transplantation. We also remain troubled by the commercialisation of living-donor transplantation and exploitation of vulnerable populations for profit.


There are solutions available. These include demonstrably successful models of kidney transplant programmes in many developing countries; growing availability of less expensive generic immunosuppressive agents; improved clinical training opportunities; governmental and professional guidelines legislating prohibition of commercialisation and defining professional standards of ethical practice; and a framework for each nation to develop self-sufficiency in organ transplantation through focus on living donation, and especially on nationally managed deceased organ donation programmes. The ISN and TTS have pledged to work together in joint co-ordinated global outreach programmes to help establish and grow appropriate kidney transplant programmes in low- and middle-income countries using their considerable joint expertise. World Kidney Day 2012 provides a focus to help spread the message to governments, all health authorities and communities worldwide. n


mortality in all patients on dialysis, patients on dialysis awaiting transplantation and recipients of a first cadaveric transplant, N Engl J Med, 1999;341(23):1725–30.


13. Sakhuja V, Sud K, End-stage renal disease in India and Pakistan: Burden of disease and management issues, Kidney Int, 2003;(83):S115–8.


14. Rizvi SAH, Naqvi SAA, Zafar MN, et al., A renal transplantation model for developing countries, Am J Transplant, 2011;11(11):2302–7.


15. Sud K, Sakhuja V, Pandey R, et al., Bioequivalence of two microemulsive preparations of cyclosporine in renal transplant recipients with stable graft function, Indian J Nephrol, 1999;9:83–91.


16. Meier-Kriesche HU, Kaplan B, Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes, Transplantation, 2002;74(10):1377–81.


17. Kasiske BL, Snyder JJ, Matas AJ, et al., Preemptive kidney transplantation: the advantage and the advantaged, J Am Soc Nephrol, 2002;13(5):1358–64.


18. World Health Organization, Global Knowledge Base on Transplantation. Available at: www.who.int/transplantation/ knowledgebase/en/ (accessed 23 February 2012).


19. Yeates K, Health disparities in renal disease in Canada, Semin Nephrol, 2010;30(1):12–8.


20. Alexander GC, Sehgal AR, Barriers to cadaveric renal transplantation among blacks, women, and the poor, JAMA, 1998;280(13):1148–52.


21. McDonald S, Incidence and treatment of ESRD among indigenous peoples of Australasia, Clin Nephrol, 2010;74(Suppl. 1):S28–31.


22. Garcia-Garcia G, Renoirte-Lopez K, Marquez-Magaña I, Disparities in renal care in Jalisco, Mexico, Semin Nephrol, 2010;30(1):3–7.


23. WHO, Transplantation Society (TTS), Organización Nacional de Transplantes (ONT), Third WHO Global Consultation on


Organ Donation and Transplantation: striving to achieve self- sufficiency, March 23–25, 2010, Madrid, Spain, Transplantation, 2011;91(Suppl. 11):S27–8.


24. Bernat JJ, D’Alessandro AM, Port FK, et al., Report of a National Conference on Donation after cardiac death, Am J Transplant, 2006;6(2):281–91.


25. Abraham G, John GT, Sunil S, et al., Evolution of renal transplantation in India over the last four decades, NDT Plus, 2010;3:203–7.


26. Shimazono Y, The state of the international organ trade: a provisional picture based on integration of available information, Bull World Health Organ, 2007;85(12):955–62.


27. World Health Organization, Forty-fourth World Health Assembly, resolution and decisions, Geneva: WHO, 1991;Resolution WHA 44/1991/REC/1, Annex 6.


28. World Health Organization, WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, Geneva: WHO, 2010;Resolution WHA63.22. Available at: www.who.int/ transplantation/Guiding_PrinciplesTransplantation_WHA63.22 en.pdf (accessed 24 February 2012).


29. Participants in the International Summit on Transplant Tourism and Organ Trafficking Convened by the Transplantation Society and International Society of Nephrology in Istanbul, Turkey, April 30-May 2, 2008, The Declaration of Istanbul on organ trafficking and transplant tourism, Transplantation, 2008;86(8):1013–8.


30. Delmonico FL, Domínguez-Gil B, Matesanz R, Noel L, A call for government accountability to achieve national self- sufficiency in organ donation and transplantation, Lancet, 2011;378(9800):1414–8.


31. United Nations General Assembly, Political Declaration of the High- level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, Document A/66/L.1, 16 September 2011. Available at: www.un.org/en/ga/ncdmeeting2011/ (accessed 24 February 2012).


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