Differences in the care of ESRD patients worldwide: required resources and future outlook

RRT has crossed the threshold of clinical applications, and its value as an effective modality for management of ESRD is fully established. However, RRT has emphasized the wide gap between developed and developing countries. Most of the developed nations are able to provide sufficient funds, directly or indirectly, for RRT and have organized cadaver donor networks. However, providing RRT is particulary difficult in the developing countries where national incomes are not sufficient to cover even the basic requirements of their citizens. Although some developing countries are making active efforts to establish cadaver donor transplant programs, these are virtually nonexistent in the majority at this time. The abject poverty in the developing world and the increasing success rate of transplantation following the discovery of cyclosporine have led to the commercialization and sale of kidneys for transplantation, an unethical practice which must be curbed. There is a near unanimity of opinion that renal transplantation is far cheaper than prolonged dialysis, and the benefit to the recipient is enormous in terms of the years of life saved and the quality of life. Until such time as cadaveric donor programs become a reality in the developing countries, short periods of dialysis followed by transplants with living-related donor kidneys appear to be the most cost-effective treatments of ESRD.