The global shortage of donor kidneys for transplantation remains one of the most pressing challenges in nephrology and transplantation medicine. The 2022 Global Observatory on Donation and Transplantation (GODT) report documented that over 2.5 million patients require kidney transplantation globally, yet fewer than 150,000 transplants are performed annually. The International Society of Nephrology has engaged with this disparity through its advocacy for expanded donation frameworks and policy reform.
ISN collaborative publications, including the Global Kidney Health Atlas (2019, Kidney International Supplements), documented that living donor transplantation rates below 5 per million population are reported in more than half of participating countries, while deceased donor programs are entirely absent in over 60 nations. These data reflect both legislative and cultural barriers to organ procurement that require context-specific policy responses.
Expanded criteria donor (ECD) kidneys and kidneys donated after circulatory death (DCD) represent significant sources of additional organs. The UNOS/OPTN data, analyzed in the American Journal of Transplantation (Merion et al., 2005), demonstrated that ECD kidney transplantation confers survival benefit compared to remaining on dialysis for most wait-listed patients, supporting a more aggressive approach to organ utilization. ISN has endorsed evidence-based frameworks for DCD kidney acceptance in countries expanding their procurement programs.
Kidney paired donation (KPD) programs have expanded the pool of compatible living donor-recipient pairs. The national KPD program developed in Canada and described by Gentry et al. in Transplantation (2009) demonstrated that multi-way chain exchanges initiated by non-directed donors significantly increase transplantation rates in incompatible pairs. International KPD pooling across ISN member countries is an emerging strategy to further increase matching efficiency.
The International Society of Nephrology has called for greater harmonization of deceased donor consent systems and transparent allocation algorithms. ISN’s position paper on access to kidney transplantation in LMICs, published in Kidney International (Garcia-Garcia et al., 2019), outlined a roadmap for developing sustainable transplant programs, addressing the legal, financial, and professional capacity-building requirements necessary for safe organ procurement and equitable recipient selection.