This document outlines the key considerations for setting up a renal transplant program in a developing country. It discusses the challenges such as lack of infrastructure, political will, and cost concerns. It recommends starting with living donation and engaging an experienced transplant center for skill transfer. It also addresses the requirements for deceased donation, including legal frameworks, ethics committees, ICU support, and training transplant clinicians. The basic requirements listed are political and economic support, legal frameworks, independent ethics, national databases, validated allocation systems, and trained transplant teams.

1. How to set Renal Transplant Program
Dr. Ala Sh. Ali
Consultant Nephrologist and Transplant Physician
Nephrology and Renal Transplantation Centre
The Medical City
Nephrology Leadership Program – Ministry of Health , Part I June 17, 2019

4. What we need to know at baseline?
• Challenges of developing countries.
• Living vs. Deceased Donation startup.
• Skill Transfer.
• Politics and Economy of transplantation.
• Public Awareness.

6. Developing country !!??
• Absence of suitable infrastructure.
• No previous exposure to transplantation.
• Concerns about cost and availability of IS.
• Political HC agenda.
• Rich people go outside for treatment.

7. Living Donation – Startup 1
Ethical consideration must be at the heart of all developments.
Transplant nephrologist and surgeon with basic training on Tx and D
Receptive hospital management
Institutional capacity
A pool of well-informed dialysis patients
Enthusiastic hospital staff
Appropriate protocol
Independent ethical assessment committee

8. Living Donation – Startup 2
I’s vital to engage an experienced centre for initiaition.
Skill transfer is required in terms of donor assessment and
surgery.
It takes several years to train transplant clinicians in the
developed world
Why it would be different in the developing world?

9. Deceased Donation - Startup 1
Institutional Committees with proper training for determining brain
death, standardized among hospitals.
When a potential donor is identified
• Tracking their condition
• Being in contact with their families
• Actions required to diagnose brain death
• Consent for donation
• Matching and allocation of organs via a validated program

10. Deceased Donation - Startup 2
• ICU staff and nursing to facilitate identification and management of
suitable brain dead, potential donors.
• Procurement and transplantation activity must be licensed or
authorized by the competent authority.
• Track the competencies of training, and equipments yearly.

18. Basic Requirements
• Political and Economic support
• Legal framework
• Independent ethical assessment
• National database
• Validated Allocation System
• Nephrologists and surgeons with transplant experience
• ICU staffing, nursing, coordinator to facilitate identification and management of suitable brain dead, potential
donors.
• Recipient education,; compliance, personal hygiene, clinic attendance
• Department of biochemistry for drug levels and virology lab testing.
• Radiology with full facilities.
• Transplant pathologist.
• Continuous training of transplant team

20. The transplant center’s clinical mission should
be viewed to provide:
1 high quality (clinical outcomes);
2 high value (cost efficient);
3 regulation compliance;
4 team-based, coordinated; and
5 patient-centered care.
6 In addition, delivery of care should strive to capture a high
percentage of market share in the local market.