Nature Reviews Nephrology, Published online: 04 June 2026; doi:10.1038/s41581-026-01090-0Medical research increasingly depends on data-driven, large-scale, multicentric cooperation; however, such cooperation remains obstructed by fragmented procedures, heterogeneity in ethics oversight, complex legal frameworks and regulatory divergence. These structural barriers slow progress, increase costs and ultimately limit benefits to patients. Harmonized, efficient processes and coherent legal frameworks that enable effective collaborative research are feasible and urgently needed.
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