Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies?

Table 1 Examples of challenges and shortages in the establishment or maintenance of kidney transplantation programs in studies from developing countries

Ref.	Country	Shortage
Budiani-Saberi and Mostafa[33], 2011	Egypt	Commercial living donors care
Haddiya et al[24], 2012	Morocco	Lacking human and material resources
Okafor[17], 2016	Nigeria	Absent DDKT
		Lacking human and material resources
Mekdim et al[32], 2017	Ethiopia	Delayed program establishment
		In September 2015, the first Ethiopian KT program was launched in Addis Ababa, in collaboration with the University of Michigan
Davidson et al[5], 2015	South Africa	Materials for immunological tests: HLA and cross-matches
Ahmed et al[31], 2018	Sudan	Materials for immunological tests
		Delayed program establishment: In 2000, it was established with the assistance of visiting teams from England
Naqvi and Rizvi[34], 2018	Pakistan	Organ selling
Guy-Frank et al[16], 2019	Guyana	Unavailability of RRT: HD and KT. Only HD before 2007 with limited sessions (high costs)
		Delayed program establishment; started in 2008 with the assistance of volunteer teams from the United States
Bakr et al[35], 2020	Egypt	Absent DDKT program
Babloyan et al[36], 2021	Armenia	Financial issues for immunosuppressive and antiviral agents
		Irregular deceased KT program; Delayed establishment of LDKT program; launched in 2002, assisted by Belgium, Switzerland, and International Society of Nephrology and Guy’s Hospital (London)
Gadelkareem et al[30], 2023	Egypt	Delayed program establishment
		Incomplete national KT program

DDKT: Deceased donor kidney transplantation; HD: Hemodialysis; HLA: Human leucocytic antigen; KT: Kidney transplantation; LDKT: Living donor kidney transplantation; RRT: Renal replacement therapy.