**3. Status of renal transplant in country**

The incidence of ESRD in Pakistan and neighboring country India would be expected to be higher since poor socioeconomic status predisposes the population to a number of infectionrelated glomerulonephritides and the incidence of nephrolithiasis is higher in both countries as they fall in a ''stone belt.''(Sakhuja, 2003) In addition 6.9 million people in country are af‐ fected by diabetes with the International Diabetes Federation estimating that this number will grow to 11.5 million by 2025. With low literacy rate and poor health facilities complications and end organ failure with diabetes and hypertension are more prevalent. If the incidence of ESRD is indeed 100 patients per million population per year, this would mean 18,000 patients for a population of 180 million in Pakistan. There are very few state run dialysis centers and most of them are small units with minimal care facilities, < 5 dialysis stations. The number of patients maintained on dialysis is likely to be < 50 patients per million population since few patients can afford this form of therapy. Sindh Institute of Urology and Transplantation (SIUT) is a semi government organization in country which cater largest population of patients suf‐ fering from any kind of kidney ailment. It is running largest hemodialysis and live related renal program not only in country but the region. This organization is unique in terms of providing free health care services to all, be it pre operative preparation, surgical procedure, life long follow up and immunosupression. (www.siut.org) Because of lack of state provided health facilities number of patients seen and treated at this hospital is beyond imagination and for same reason patients do comply during follow up and long term data from this institution is more reliable and representative.

Renal transplant started in country in 1979 from living related donors, initially the activity was as low as < 50 /year, which rose to about 2500 kidney transplants / year in 2007. Most of these were unrelated donor transplants done at private sector. In March 2010 Pakistan was fortunate to have been able to pass a viable and authentic transplant law and activity of unrelated donor transplant decreased. Deceased donor transplant yet has to take off in country, though few have been done from non heart beating donors, organs supplied by Euro-transplant founda‐ tion and five local deceased donors.
