World Organ Donation Day: Understanding End-Stage Renal Disease And The Lifeline Of Kidney Transplant

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The path forward lies in a three-pronged approach: prevention, early diagnosis, and improving transplant access
End-Stage Renal Disease (ESRD) the final and most critical stage of chronic kidney disease (CKD) is emerging as a pressing public health challenge in India. At this stage, the kidneys lose nearly all function, making life-sustaining treatments like dialysis or kidney transplantation essential.
According to Dr Tarun Singh, Consultant Urology and Renal Transplant, Sharda Care Healthcity, the numbers paint a sobering picture, 'Over 128 million Indians are estimated to be living with CKD, and 200,000–250,000 new ESRD cases are added each year. Diabetes and hypertension together account for nearly 70% of cases, with others linked to chronic infections, glomerulonephritis, or genetic disorders."
Dr. Udit Gupta, Consultant Nephrologist and Renal Transplant Physician at Indian Spinal Injuries Centre, echoes this concern, pointing out that lifestyle changes, urbanisation, and unhealthy diets are fuelling the surge: 'We are seeing more patients now presenting at Stage 5 than ever before. Early stages are often silent, which means many are diagnosed only when kidney function is severely compromised."
The Silent Progression
CKD advances through five stages from mild impairment to complete kidney failure. Dr. Singh explains that early stages often go unnoticed,'Sometimes, patients are diagnosed when over 70% of kidney function is already lost. At this point, dialysis or kidney transplantation becomes essential."
Dialysis, whether hemodialysis or peritoneal, is a vital bridge for ESRD patients. However, both specialists emphasise that transplantation remains the gold standard. Dr. Gupta notes: 'A kidney transplant offers the best long-term survival and quality of life, enabling patients to return to work and daily activities more fully."
Dr. Singh adds that advances in surgical techniques and immunosuppressive therapies have pushed one-year graft survival rates above 90% in many Indian centres a figure comparable to global benchmarks.
The Transplant Gap
Despite the clear benefits, there remains a huge disparity between the number of patients needing transplants and those receiving them. Dr. Singh highlights: 'While over 200,000 patients require a transplant annually, only around 10,000–12,000 are performed, with 85% from living donors. Deceased donor rates remain below 1 per million population."
Most transplants in India rely on living donors, often family members. Dr. Gupta points out that expanding deceased donor programmes, encouraging paired kidney exchanges, and strengthening infrastructure could dramatically improve access for patients without a living match.
Prevention as the First Line of Defence
Both experts agree that prevention and early detection can reduce the burden of ESRD. Dr. Gupta advises regular screening for high-risk groups, especially people with diabetes and hypertension, along with lifestyle interventions: 'Controlling blood sugar and blood pressure, avoiding harmful medications, staying hydrated, and making healthy choices can significantly reduce risk."
Dr. Singh adds that early screening and preventive care for at-risk populations could 'dramatically reduce progression to ESRD and the need for transplantation."
Looking Ahead
The path forward lies in a three-pronged approach: prevention, early diagnosis, and improving transplant access. Raising public awareness about organ donation, closing the gap between demand and availability, and building robust deceased donor programmes could transform kidney care in India.
As Dr Gupta concludes, 'If we combine prevention, early detection, and wider transplant access, we can change the future of kidney health in India."
First Published:
August 13, 2025, 12:17 IST
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