In the Philippines, an estimated 122 persons per million population develop end stage renal disease (ESRD) each year. Based on a population of 89 million as of 2007, we expect 10,858 Filipinos to develop kidney failure annually. Figure 1. These patients would need lifetime dialysis or a kidney transplant in order to survive. In 2007 however, only 7,469 patients started chronic dialysis therapy or 68% of the expected patients who developed ESRD. The remaining 32% or 3, 511 patients were not able to start dialysis probably due to financial constraints and probably just died. Patients may have been misdiagnosed or there may have been a lack of access to medical care or dialysis centers which may have contributed to the low number of patients starting dialysis.

Figure 1. Number of patients who start dialysis each year.
Reference: Philippine Renal Disease Registry Annual Report for 2008

The poor survival rate of dialysis patients is seen in the number of patients undergoing dialysis (prevalence) as shown in Figure 2. If all new patients are able to continue dialyzing, then the projected prevalence from 2002 – 2007 would be around 35,000 patients, since about 500 patients are added to the number of new patients starting dialysis each year. However, there are only 7251 patients dialyzing annually in the last 3 years. It is worst in 2002-2004 because the prevalence was lower than the new patients who started dialysis. This means that patients are not surviving more than a year from starting dialysis.

Figure 2. New Patients who started Dialysis each year versus the Prevalence of patients on Dialysis each year.
Reference: Philippine Renal Disease Registry Annual Report for 2008



We can assume that at least 50% of ESRD patients are medically suitable for a kidney transplant. Patients with severe heart disease or who have certain infections may not be good candidates for transplantation. Thus in 2007 we expected about 3,500 patients to join the Transplant Candidate Waiting List however only 236 patients were registered on the Waiting List that year.

From 2002 to 2007, the number of patients in the Transplant Candidate Waiting List has grown from 65 to 236. Each year there are about 76 new patients added to the list for either a deceased donor or a living non-related donor. Each year however, many patients die while waiting for a donor. Figure 3. Among an average of 187 patients in the Transplant Candidate Waiting List, 7% die while waiting for a donor.

Only 510 Filipinos had a kidney transplant last year. (95%) were from living donors and only 5% were from deceased donors. Only 22% of these patients were enrolled in the Transplant Candidate Waiting List at the Human Organ Preservation Effort (HOPE) of the National Kidney and Transplant Institute.

The patients transplanted last year represent only 14% of the patients who were eligible for a transplant. There remains a large gap between those who need a transplant versus those who are transplanted. The rest remain on dialysis until their finances run out or die.

Figure 3 Number of patients in the Transplant Candidate Waiting List
Reference: Philippine Renal Disease Registry Annual Report for 2008



Unlike other developed countries like the United States, majority of renal transplants done in the Philippines come from living donors. Efforts to expand the Deceased Donor Program has been curtailed by inadequate logistic support, very low social acceptance of the concept of Brain Death amongst the general public and even in the healthcare community. Likewise, on the other end of the spectrum, transplant candidates prefer living donors over deceased donors due to better outcome. We have yet to maximize its potential as an organ donor source.

In 2007, of the 73 referrals for potential deceased donation, only 26 (36%) consented to donate the organs of their loved one, 16 (22%) denied consent, 31 (42%) had pending consent, wanting to wait for other members of the family to provide communal consent. These potential donors went into cardiac arrest before final consent was given. Of the 26 whom consent was obtained, 15 (58%) were able to donate, 11 (42%) were found medically unsuitable.