Renal transplantation is the preferred therapy for end stage renal failure with graft survival rates in excess of 90% at 1 year and 85% at 5 years. However with an estimated incidence of ESRF of > 100pmp we only transplant at a rate of 8 pmp. They fulfill less than 1% of our transplant needs by performing about 1,000 transplants per year. Dialysis costs $40 per session and the initial cost of transplantation more than $10,000 which is exorbitant for the vast majority. Economic deprivation and the meager expenditure on health care translate into a poor transplantation activity. Although economic constraint is the main reason for poor transplantation activity, it is not the only reason. Pakistan, although it has technical expertise, suffers jointly from economic difficulties and cultural and societal apathy towards organ donation. This stems mainly from a lack of public awareness about organ donation. There is reverence for the dead in a society based on the belief that removal of organs is mutilation of the body, which is the sacred property of God. Living donation is perceived as disabling of a normal healthy life. Thus the bill for cadaveric organ donation in Pakistan has remained in the Senate awaiting approval for the past 10 years as societal apathy is translated into legislative apathy due to lack of public pressure.
Although living donors are the only source of organs in Pakistan, medical problems, social issues and cultural beliefs suppress donation. At SIUT which only performs living related transplantation, from an initial average of 6 potential donors per recipient family, no more than 1.6 donor per recipient remain at the end of the process. Poverty and the absence of any law related to organ transplantation, has lead to proliferation of paid unrelated living donor activity which now outnumber living related transplants.
Under such a scenario, local philanthropy has come to play a vital role in propelling transplantation. SIUT developed a model based on self-help – a model based on a community-government partnership. The government fulfills about 40% of the total budget and the rest comes from the community as donations. The scheme has been extremely successful in providing free medical care and renal support to thousands of patients.