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South African transplantation--where are we now and where should we go next?

South Africa should strive to provide transplantation leadership and support in the developing world. This requires renewed efforts in obtaining and utilising organ donors. Donation after cardiac death is limited to Groote Schuur Hospital. Consent rates for this type of organ donation are higher in underdeveloped countries, as reflected in increased consent rates at Groote Schuur Hospital. This programme has huge potential, especially in state-sector hospitals where resources to treat head-injured patients are limited. Factors inhibiting deceased donation from growing in South Africa are religious and social issues, lack of government support (variable organisational systems and variable infrastructure), inappropriate allocation of resources, and a lack of active effort by transplant co-ordinators and doctors in this field. Further obstacles in South Africa are inadequate disease prevention programmes, lack of awareness about brain death diagnosis among health care workers, and lack of funding. Despite a low average income rate in Iran, living and deceased donation is taking place and deceased donation increases yearly. 2 In most countries where commercial transplantation took place it had a huge impact on organ transplantation. Deceased donation rates fell dramatically and transplantation for the local population decreased. This is not currently taking place in South Africa, probably because of huge efforts by the Transplantation Society and the Istanbul Declaration Custodian Group. 3 This continuing worldwide problem warrants constant attention. Liver transplantation in South Africa is limited to deceased donor liver transplantation. Turkey, Egypt and Iran have active living related liver transplantation programmes, and most transplants are done for paediatric recipients. There is no living related liver transplant programme in South Africa, despite a favourable recipient pool at Red Cross War Memorial Children’s Hospital. South Africa must compare itself to other developing countries regarding organ donation and transplantation. We cannot compete with the developed world in terms of infrastructure, support and funding. However, transplant surgeons and physicians must renew efforts to establish and preserve these programmes in the state and private sectors. It is important that continuous efforts be made to increase our deceased donation rates to serve the population awaiting organs.