Corresponding Author: Mitra Mahdavi-Mazdeh, MD Management Center for Transplantation and Special Diseases, Vanak Sq, Tehran, Iran Tel: +98 21 8864 4515 Fax: +98 21 8864 4516 E-mail: mmahdavi@tums.ac.ir Dialysis and kidney transplantation are the only treatment options available for patients suffering from end-stage renal disease (ESRD). More than 1 million patients are on renal replacement therapy (RRT) worldwide, and it is forecasted that their population will be doubled within the next decade. There is a clear direct relationship between a nation’s gross national product and the availability of RRT. Approximately, 90% of patients with ESRD come from developed nations.(1-3) Conversely, for the vast majority of patients who live in developing countries (roughly 85%), dialysis and transplantation are unaffordable.(4) Generally, a series of influencing factors dictate the gross diversity in making decisions about the rates and modalities of the RRT. There are different reported incidences of ESRD in different countries, on the one hand, and significant variations in the culture, socioeconomic status, dialysis costs and quality, reimbursement structures, and discrepancy between the demand and supply of organs for transplantation, on the other hand.