Changing the reality of renal failure in Zambia: An Update on the Kidney Transplant Program in Lusaka
By Mohammed Al Kadhim
November 10, 2025
Stanford Surgery has launched a multidisciplinary program to transform thousands of lives in Zambia. What started as a single ACS-HOPE training visit has evolved into a much larger effort to build and strengthen renal failure care. Dr. Tom Pham, a clinical associate professor in our Division of Abdominal Transplantation, has led the effort following his initial observations and the opportunities he saw during his first visit to Zambia. His experience led to a transformation in thinking about how Stanford could impact care for patients 10,000 miles away. Pham worked to establish and support a kidney transplant program in Zambia, building up networks and seeking help. On his most recent trip, he was accompanied by Stanford faculty members Dr. Ken Tran from the Division of Vascular Surgery and Dr. Maha Mohamed from the Division of Nephrology in the Department of Medicine to strengthen pre- and post-transplant patient support.
Read their accounts:
Dr. Pham updates us on the most recent developments and his on how a reliable kidney transplant program would impact Zambia’s overall economy, and the economic benefits that might accrue to society generally.
Pham: What was obvious from my first visit, in June of 2024 is that there was a collective alignment in goals: what ACS-HOPE aimed to achieve with an ongoing visiting surgeons program, our vision at Stanford’s Global Engagement program, and what the surgeons and nephrologists at University Teaching Hospital (UTH) wanted all aligned in helping develop a sustainable and independent program. They desperately wanted to provide kidney transplant surgeries to the local population with the resources they had, but they were doing it in a way that was not sustainable, so I felt that there were opportunities for us to help achieve this.
Our goal was upskilling their surgeons and transferring new skills to surgeons, nephrologists and staff of other specialties who are involved in kidney transplants. As the idea developed, there were local champions at UTH hospital both in surgery and medicine who were willing to take this on. Their enthusiasm and dedication made it very easy to see these opportunities, and to engage for making thing happen on the ground very quickly. They were so eager to do this.
The way I looked at it was that I needed to develop a training team which included visiting surgeons and nephrologists to help train a skilled local team there in Lusaka. At the outset, Drs. Tom Weiser and Sherry Wren helped guide me and connected me with individuals both in Lusaka and also in the ACS-HOPE program. After my return from the first trip, I reached out to every ACS-HOPE center faculty liaison, asking them to connect me with their transplant surgeons. I talked one on one with each of the transplant surgeons who had participated in ACS-HOPE, and I shared my vision.
The first one who reached back to me was Dr. Albin Grich from UCLA who had experience teaching laparoscopic skills in central and South America. I went through The American Society of Transplant Surgeons and further networked with surgeons interested in international work. Most notably Dr. Jeffery Punch, who used to be the director of the transplant program at the University of Michigan and is now focusing his efforts to help building a kidney transplant program in Rwanda, really helped guide me and understand the steps that he had followed in Rwanda to make his work successful there. We discussed how I could replicate it to establish a kidney transplant program in Zambia. The team of healthcare providers who assisted Dr. Punch in Rwanda are now helping develop the program in Zambia.
On the Zambia front, the key role players were Drs. Victor Mapulanga, the academic chief of surgery there who was very excited by the idea of developing a kidney transplant program. There were also the OR staff, the nurse coordinators, anesthesia personnel and others. But the person who is spearheading the entire effort in Lusaka is Dr. Aggrey Mweemba who is the chief nephrologist of the country. Working with the domestic partners at UTH, we were able to establish subgroups within the kidney transplant group, including a group that focuses on laparoscopy development. The nephrologists at UTH are now directly involved and they are focusing on developing systems to improve nephrology care, both to organ donors and to kidney transplant recipients. It’s a team effort that requires everyone involved to be on board.
I just returned from my most recent trip, and it was really nice to visit Lusaka again. This was my third time, and I was with two Stanford colleagues Drs. Maha Mohamed and Ken Tran, as well as Dr. Tsuyoshi Todo from Cedar Sinai. It was great to be with a multidisciplinary team and get input from everyone.
Organ transplantation is a multidisciplinary effort not only in the US, but also in all other countries that have a robust multi-organ transplant programs. While the surgery itself is a key portion of the work, it’s just one piece of the whole puzzle. The patient care before and after surgery is crucial to the success of transplant
Our biggest achievement in this multidisciplinary trip was to display and show our colleagues at UTH how a multi-disciplinary team works together. It definitely was a culture change for them but they realized how much a multi-disciplinary approach could help them in providing the best care as a team, and the benefits to patient outcomes.
As a vascular surgeon, Tran focused on arteriovenous(AV) fistula development. He facilitated training in AV fistula creation for surgeons across Zambia. Mohamed is a nephrologist, and she has developed research collaborations and is assisting with the creation of the first nephrology fellowship in Lusaka. Todo and I trained the surgeons in kidney transplantation and donor nephrectomies. We also helped refine their peri/post operative protocols. So, with the above accomplishments, this training collaborative is more than just kidney transplant but really encompasses the improvement in care of dialysis patients.
To improve the pre- and post-surgery care, it was important that we avoid the approach of translating what we do in the US and expect it to be helpful in Zambia but instead think about ways to modify our practices in a manner compatible with their available resources, their healthcare system, their traditions and culture. Patient safety and wellbeing are the most important aspects, and they should never be compromised under any circumstances. So, working side-by-side with our local collaborators was key for transferring knowledge safely and effectively. We are planning another trip to Lusaka in November, and I am making the arrangement for two surgeons from other institutions to visit Lusaka and contribute to this collective effort.
In low-income countries, health services, including dialysis, which is a huge burden worldwide, come mainly from the government. Dialysis is a costly and potentially temporary solution that consumes time, labor, energy, and financial resources from both the country’s health system and a patient’s family. It’s important that we work with UTH, which is the country’s primary public hospital providing healthcare services to the vast majority of the population who are covered by its public health insurance. Despite that, it remains costly and, in many situations, entire families must contribute financially to help cover the costs of dialysis for a loved one. Kidney failure patients spend several hours twice or three times a week at dialysis centers. This keeps them from working or caring for their family.
The only way to get someone off dialysis is through a kidney transplant, so if you don’t have a kidney transplant program, more people will be dependent on dialysis, for the rest of their lives. We know that the number of renal patients is increasing worldwide, so getting patients off dialysis will lift this burden from them so that they can continue living their life.
We are going to measure the impact by assessing the cost of dialysis, the average out of pocket cost prior to transplant, the cost of transplant and then make a comparison with the benefits after receiving a transplant.
From the beginning, Stanford Surgery Global Engagement support has been truly invaluable. The mentorship and guidance were priceless at every single step. I never had any experience in global health before this, but Drs. Wren and Weiser mentored me and connected me with the right people. In addition to guidance, Global Engagement has been there to provide financial support from day one by awarding our training consortium a seed grant and was always proactive in providing excellent logistical services and has highlighted and communicated our activities on its media platform.
