[Preventive renal transplantation: considerations and future plans].

Area of Science:

• Nephrology and Transplant Surgery
• Public Health Policy
• Organ Donation and Transplantation

Context:

• Kidney transplantation is the optimal therapy for uremic patients, yet transplant waiting lists remain stable in Italy.
• Annual kidney transplants are not increasing, with a projected decrease for 2007, exacerbating patient access to this life-saving procedure.
• Debate continues regarding the inclusion of pre-dialysis patients on deceased-donor waiting lists, with regional variations in practice.

Purpose:

• To evaluate the feasibility and impact of including pre-dialysis patients on kidney transplant waiting lists.
• To explore strategies for optimizing kidney transplant access, particularly for patients not yet on dialysis.
• To assess the current balance between kidney transplant demand and supply in Italy, focusing on regional dynamics.

Summary:

• Kidney transplantation offers the best outcome for uremic patients, but stable waiting lists and stagnant transplant numbers in Italy present challenges.
• While some regions like Tuscany allow pre-dialysis patients on waiting lists, this practice is not widespread.
• Strategies to improve access include expanding living donor kidney transplantation and earlier admission of pre-dialysis patients to waiting lists, especially given declining organ donations.

Impact:

• Implementing earlier waiting list admission and promoting living donor programs could significantly increase kidney transplant rates.
• Proactive management of pre-dialysis patients on waiting lists can improve graft survival and patient quality of life.
• Addressing organ donation decline and optimizing waiting list policies are essential for meeting the growing demand for kidney transplants.