Renal transplantation in indigenous populations

Renal disease is a common problem in many indigenous populations, but the t reatment of endstage renal disease (ESRD) by dialysis and transplantation p resents special problems in such populations. Many of these problems are il lustrated by the attempts to provide renal transplantation for the Aborigin al Australian population Factors such as cost, religious and cultural attit udes, endemic infections, causes of end-stage renal failure, compliance, ra ce, logistic problems and equitable allocation of organs influence not only the provision of transplantation bur also its outcome. In developing count ries where cost is the overriding factor determining provision, transplanta tion even in the non-indigenous populations is rarely a practical option fo r ESRD. In developed and affluent countries, such as Australia, cost: is no t the major factor to be considered in providing a satisfactory renal trans plant program. Cultural attitudes, compliance, logistic problems, and the e quitable allocation of organs are greater problems. Nevertheless in develop ed 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 identif ication of the causes and risk factors of renal disease. Furthermore, a suc cessful program will only be developed if it involves the indigenous commun ities themselves in the development and maintenance of the program.