I recently sat with a patient who had traveled from a distant province to reach our transplant center. She was exhausted and hopeful. I’ve seen far too many patients make such pilgrimages. In the Philippines, kidney transplants remain confined to a few major hospitals in cities. This centralization forces patients to uproot their lives for a chance at a new kidney. It shouldn’t be this hard: where you live shouldn’t determine if you live.

Even for those who reach a transplant center, financial barriers can be equally daunting. A kidney transplant here can cost over a million pesos — an impossible sum for most families. Our national insurance’s “Z Benefit” transplant package helps by covering a large portion of this cost. From an initial P600,000 a decade ago, it now shoulders up to around P2.1 million (depending on the case), including surgery and initial immunosuppressants. Still, gaps remain. Many patients struggle to afford the pre-transplant tests or the lifelong medications and follow-up care that aren’t fully covered. I’ve seen patients postpone getting on the transplant list to scrape together funds, even with insurance support. No one should have to choose between debt and a kidney, yet that’s the dilemma many families face.

Workforce shortages threaten to undermine progress. Kidney transplantation is specialized, and only so many surgeons, nephrologists, and nurses can do it. Most are clustered in Metro Manila and a few other cities. Outside those hubs, some hospitals have the will and infrastructure, but not the people — some regions don’t have a transplant surgeon at all. Meanwhile, many specialists leave for jobs abroad or simply burn out. Even with more funding and new facilities, we might still lack the hands to perform the surgeries or care for patients afterward. We need to train more transplant professionals and give them reasons to practice in underserved areas.

Another under-addressed issue is the opacity of data. Basic questions like how many Filipinos get a kidney transplant, or how long patients wait, have no easy answers. Centers keep their own records, but there’s no unified public reporting of outcomes or waiting lists. That makes it hard for patients and policymakers alike to see the big picture. And lack of data means a lack of accountability — problems can easily hide in the shadows. For patients, not knowing where they stand in line or their odds of getting a deceased-donor kidney is deeply unsettling.