A transplant nephrologist and Medical Director of Abia State Specialist and Diagnostic Hospital, Dr Chimezie Okwuonu, has called for urgent reforms in Nigeria’s kidney care system.

The physician warned that without stronger financing, improved transplant infrastructure and wider adoption of innovative therapies, rising kidney disease cases may continue to overwhelm patients and the health sector.

Okwuonu made the call while presenting Nigeria’s kidney transplant experience at an international nephrology meeting, where he outlined progress made in transplantation, persistent gaps in care delivery and opportunities for strengthening renal services in the country.

The nephrologist, who has been at the forefront of advocacy for improved kidney care and transplant services, said Nigeria had recorded measurable progress in transplantation, with 19 transplant centres established and 11 actively performing procedures in the last three years.

According to him, the country has carried out about 2,100 kidney transplants, with nearly 1,958 done in private facilities and 142 in public hospitals, marking significant growth from the early years when only 308 procedures were recorded between 2000 and 2016.

He said between 2017 and 2026, the number of transplants rose to 1,892, with Nigeria now performing between 160 and 190 kidney transplants annually.

Okwuonu attributed the progress to growing local expertise, international partnerships and expanding nephrology training, but said major structural challenges continue to limit access and outcomes.

He said funding remained one of the biggest obstacles, noting that transplantation costs range between $5,830 and $18,000 in public institutions and about $22,000 in private facilities, excluding the lifelong costs of immunosuppressive drugs and post-transplant monitoring.

The nephrologist said cost was also driving many kidney patients to adopt medically unsafe coping strategies, including reducing dialysis frequency.

He had earlier warned that patients with end-stage kidney disease cannot survive on one dialysis session weekly, saying many patients resort to the inadequate schedule only because they cannot afford recommended treatment.

According to him, this financial burden partly explains why many patients abandon transplantation.

Okwuonu had also disclosed that about 88 per cent of kidney patients who need transplants are unable to proceed because of cost, a situation he said underscores the urgent need for stronger insurance support and government intervention.

He called for the National Health Insurance Authority to expand coverage to include transplant procedures and post-transplant care, arguing that out-of-pocket payment has made renal care inaccessible to many Nigerians.

The physician also raised concern over increasing transplant failures in the country, linking them to poor medication adherence, weak post-transplant monitoring, laboratory constraints and inability of many recipients to sustain long-term care.

He said improving outcomes would require strengthening Human Leukocyte Antigen laboratories, increasing access to specialised diagnostics and establishing a unified national transplant registry.

According to figures presented by him, Nigeria has about 300 consultant nephrologists, though only about 30 are actively involved in acute transplant care, while the number of transplant surgeons remains about 40.

He said shortage of trained personnel, worsened by brain drain, continues to slow expansion of transplant services.

Okwuonu, however, said Nigerian specialists have continued to record breakthroughs despite the constraints.

He cited the successful third kidney transplant performed in a Nigerian centre on a 44-year-old man who had previously lost two grafts abroad as evidence of growing local competence in managing highly complex cases.

He also pointed to therapeutic apheresis, a blood-cleansing therapy being promoted by researchers, as one of the major innovations capable of improving transplant outcomes.

According to him, the therapy has emerged as a game changer in managing antibody-mediated rejection and enabling incompatible transplants previously considered difficult.

Recent research involving 131 patients and more than 860 procedures had similarly pushed the therapy as a promising tool in kidney transplantation.

Okwuonu, who was recently elected to the board of the International Society for Apheresis, said the position offers an opportunity to advance access to such therapies in Africa and influence global guidelines relevant to low-resource settings.

He had also been invited to speak at a medical congress in Thailand, where he shared perspectives on apheresis and transplant innovations, further raising Nigeria’s profile in global nephrology.

His emergence on the ISFA board came shortly after a US-based Nigerian professor became the society’s first Black president, developments stakeholders described as significant milestones for African representation in global kidney care leadership.

Drawing from the experience of the Federal Medical Centre, Umuahia, which he described as the pioneer transplant centre in the South-East serving over 25 million people, Okwuonu said long-term complications observed in local practice include chronic rejection, recurrent kidney disease, infections and death.

He said those realities reinforce the need to move beyond performing surgeries to building sustainable systems for long-term transplant survival.

The nephrologist identified some strengths in Nigeria’s transplant journey to include international partnerships, growing multidisciplinary teams, increased nephrology capacity and emerging expertise in apheresis.

He, however, said funding gaps, supply chain instability affecting transplant drugs, limited laboratory support and absence of a deceased donor programme remain major barriers.

He called for a comprehensive National Renal Care Policy that would include mandatory funding for transplant infrastructure, support for research, decentralised dialysis and transplant satellite centres, and legislative reforms to support deceased donor transplantation.

According to him, Nigeria must also invest in primary care nephrology to improve early detection of chronic kidney disease and reduce progression to kidney failure.

He said the country should target universal renal coverage involving dialysis and post-transplant care while pursuing a stronger deceased donor programme within the next five years.

Beyond transplantation, Okwuonu has also been vocal on wider health policy issues.

He was among stakeholders who faulted proposals seeking to compel public servants to use only public hospitals, arguing that such measures cannot fix Nigeria’s broken health system without addressing underfunding and infrastructure decay.

He said meaningful reform should focus on rebuilding public hospitals and strengthening accountability rather than imposing restrictions.

His interventions have also come amid broader concerns in the health sector, including repeated tensions between doctors and government over welfare issues, which recently led the Nigerian Medical Association to suspend a planned strike after granting the Federal Government a fresh ultimatum.

Observers say Okwuonu’s advocacy has increasingly combined clinical innovation, policy engagement and systems reform.

In his presentation, he urged government, private sector actors and international bodies to deepen collaboration to close remaining gaps in kidney care.

He also called on global institutions to support resource-sensitive guidelines that reflect the socio-economic realities of practising nephrology in sub-Saharan Africa.

For him, the progress recorded so far shows that kidney transplantation can succeed in Nigeria if backed by stronger policy and investment.

“We have made progress through local innovation, partnerships and resilience, but sustaining and expanding those gains will require deliberate reforms,” he said.

As chronic kidney disease continues to rise and more Nigerians struggle with the high cost of renal care, experts say the reforms being pushed by Okwuonu and other stakeholders may prove critical to the future of kidney health in the country.