Renal transplantation in indigenous populations

Summary: Renal disease is a common problem in many indigenous populations, but the treatment of endstage renal disease (ESRD) by dialysis and transplantation presents special problems in such populations. Many of these problems are illustrated by the attempts to provide renal transplantation for the Aboriginal Australian population. Factors such as cost, religious and cultural attitudes, endemic infections, causes of end-stage renal failure, compliance, race, logistic problems and equitable allocation of organs influence not only the provision of transplantation but also its outcome. In developing countries where cost is the overriding factor determining provision, transplantation even in the non-indigenous populations is rarely a practical option for ESRD. In developed and affluent countries, such as Australia, cost is not the major factor to be considered in providing a satisfactory renal transplant program. Cultural attitudes, compliance, logistic problems, and the equitable allocation of organs are greater problems. Nevertheless in developed countries such as Australia it should be possible to provide successful renal transplantation for the indigenous population with ESRD provided that it is accompanied by intense programs of disease prevention, after identification of the causes and risk factors of renal disease. Furthermore, a successful program will only be developed if it involves the indigenous communities themselves in the development and maintenance of the program.