The debate on preemptive transplantation: queries and limits

Compared to kidney transplants performed in patients already on dialysis, preemptive kidney transplantation offers advantages both clinically and in terms of quality of life. However, in Italy, giving predialysis patients access to the waiting list remains an issue of debate. It has been estimated that, with the inclusion of predialysis patients, almost 20,000 patients would be candidates for preemptive kidney transplants. Currently, in Italy more than 7000 dialysis patients are on the waiting list, the average waiting time is longer than three years, and the number of new admissions is higher than the number of transplants performed. Therefore, the activation of a preemptive kidney transplant program from cadaver donors would raise equity issues related to organ allocation.