Renal replacement therapy in India: Promising future with kidney paired donation transplantation

The prevalence of CKD is increasing worldwide. There is tremendous imbalance in organ supply and demand worldwide. India is having mainly living donor (up to 90%) kidney transplantation program. Majority (up to 45%) of the living donors, although healthy and willing, are rejected due to ABO incompatibility. Deceased donation contributes to <10% of KT in India. Kidney paired donation, ABO incompatible KT, desensitization protocols, and marginal living donors are the ways to expand the living donor pool. The age at time of CKD reporting is less as compared to western stand and economic constraints are the most important hurdle in access to renal replacement therapy. The best long-term patient and graft survival is seen in KPD, which is cost effective and can be performed in all transplant centers. KPD has potential to expand the KT rate by 25%. The state and national KPD program will increase the donor pool and it increases the transplant rate in KPD. The harmony and co-ordination in different transplant centers, uniform guidelines to accept donor and patients for transplantation and computer software are required for the national KPD program.