Paraguay's IPS faces crisis in kidney transplants amid high costs and staff precarity

A report from Paraguay's Institute of Social Welfare (IPS) has exposed the immense costs and profound challenges surrounding kidney transplants, revealing a system plagued by millions in investments, severe deficiencies, precarious medical labor, and a collapsing situation for insured patients. The findings were presented during a session of the IPS Administrative Council.

Dr. Gloria Orúe, the IPS Renal Transplant Coordinator, presented a detailed technical report on the state of renal patients, comparative costs of dialysis versus transplantation, and structural shortcomings faced by medical staff. She indicated that the nephrology service operates with 37 full-time nephrologists and approximately 50 doctors in total, supported by internists, cardiologists, and oncologists covering critical on-call duties. With a monthly demand of around 1,500 interconsultations and nearly 4,000 dialysis sessions, both in-house and outsourced, the hospital's operational capacity is stretched to its limit.

The transplant team also emphasized that IPS is virtually the sole institution in Paraguay performing these procedures on elderly patients, extending historical margins and achieving successful outcomes in older adults. However, a significant point of concern raised during the session was the contractual situation of the personnel. Medical teams acknowledged sectors with high labor vulnerability and a historical lack of institutional support for international training. They openly denounced the mistreatment and precarious conditions faced by contracted professionals, citing institutional barriers that discourage talent retention. Nationally, Paraguay has an estimated 108 nephrologists, with only about 70 to 80 actively practicing, indicating a chronic shortage of specialists.

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We have to change this mistreatment of colleagues who go abroad to specialize and who, because they are on contract, do not...