Equitable access to pediatric kidney transplantation: bridging the gap-the view from low- to lower-middle-income...

Access to pediatric kidney transplantation, the gold standard treatment for children with chronic kidney failure, remains markedly unequal across the globe. This disparity poses disproportionately greater challenges for children in low- and lower-middle-income countries (LLMICs). Compounding the issue, there is a scarcity of data from low-resource settings due to the lack of centralized databases and official registries, which obscures the true burden of the problem. Hence, the underlying causes of these disparities in LLMICs remain inadequately analyzed and addressed. A comparative evaluation of pediatric kidney transplantation in high-income countries (HICs) versus LLMICs reveals several key barriers: a shortage of trained medical and paramedical personnel, infrastructural limitations, inadequate pediatric dialysis facilities, a critical shortage of organs, limited access to specialized post-transplant care, and the influence of sex, sociocultural, and socioeconomic factors. Of these, organ shortage, due to misconceptions surrounding living-related donation and the absence of robust deceased donor transplantation programs, emerges as a major bottleneck. To address these challenges, LLMICs can adopt strategies from successful HIC models and breakthrough low-resource-setting strategies. These include education and awareness campaigns, supportive policies and advocacy initiatives, capacity building, strengthening deceased organ donation, ensuring a consistent supply of affordable, standard-quality medications, mobilizing community support, fostering national and international collaborations, and improving data collection and promoting research. Equitable access to pediatric kidney transplantation requires the committed involvement of key stakeholders: patients and caregivers, healthcare professionals, and governments. Their sustained, coordinated efforts are essential to overcome geographical, financial, and sociocultural barriers to ensure life-saving kidney transplantation for all children with chronic kidney failure.