Finding solutions to the lack of organ donation in South Africa

Posted on August 23, 2019

South Africa lacks organ donors owing to the cultures of its residents

South African organ donation rates do not compare well with those of other countries, despite it earning its rightful place in organ donation and transplantation history as the site of the first heart transplant. Some may argue that the reason for South Africa’s low number of organ donations is the different cultures and religions in South Africa prohibiting potential donors and their families from providing consent to organ donation and transplantation. In the authors’ opinion, however, the low transplantation rates can be attributed to a multitude of factors.

Organ donation and transplantation is the process of surgically removing an organ or tissue from one individual and giving it to another individual in need. The recipient requires the transplant of this organ or tissue to survive owing to their own organ or tissue being damaged by disease or injury. Organs that can be donated include the heart, liver, pancreas, kidneys and lungs, whereas tissues include corneas, skin, bone and heart valves.

During 2017 the Organ Donor Foundation (ODF) conducted a survey which showed that 4 300 adults and children were awaiting organ donation, with only 0,2% of the South African population being registered as donors. During 2017 only 370 organ transplantations were performed in South Africa, compared to 139 024 performed globally. Similarly, in 2018 only 361 transplantations were performed in South Africa, compared to 19 513 performed in the United States of America.

Uneducated

Professor Magda Slabbert, a medical law specialist from UNISA, states that ‘Our research has proven that the main obstacle is ignorance, which is then thrown under the carpet of culture. Once you engage and explain how organ donation works, there is much greater acceptance.’ Very often, when approached by medical staff and transplant coordinators, patients’ families ask questions such as ‘What will it cost?’ ‘Will we get paid?’ and ‘How are his/her organs alive but he/she isn’t?’ This proves that the apparent lack of awareness and knowledge among South Africans regarding organ donation and transplantation and the fundamental principles of brain death, as well as the existence of biological processes allowing organ donation, need to be addressed.

Distrust in the health system

The so-called ‘Kidneygate’ saga of 2001 started a culture of suspicion surrounding organ donation and transplantation in South Africa. Suspicion lead to distrust, introducing another reason why patients and their families refuse organ donation. Questions such as whether medical staff would profit from the donation of individuals’ organs or whether patients in end-of-life situations may receive decreased quality of care in order to ‘aid’ in their death and thus speed up the organ procurement process were raised. This led to patients and their families opting for the easy way out of organ donation discussions, which is simply to refuse it.

Challenging concepts

The challenging concept of brain death also serves as a big contributor to the low donor pool, hindering the process not only from the patient’s family’s perspective, but also from the medical professional’s perspective. Referral of brain-dead patients for organ transplantation has been suboptimal and may be due to the medical professional regarding the patient’s demise as his or her failure to manage the patient appropriately, or even a lack of knowledge regarding the principles of organ donation and transplantation.

Registration means nothing

Another flaw in the South African organ donation system, which consists of only 200 000 registered donors out of a population of almost 53 million, is the fact that registered organ donors are required to carry their organ donation cards with them in order to be identified as a potential organ donor. In the event that a patient who is declared brain-dead or in any other end-of-life situation does not have their organ donation card with them, it is solely up to the doctor or family members whether to consider organ donation or not.

To make matters worse, more often than not, individuals who register as organ donors do not discuss this with their loved ones, and as a result, said individuals may be denied opting for donation owing to disbelief and uncertainty on the family’s part.

Solutions

In the authors’ opinion, a couple of the solutions can be employed to increase the number of organ donations in South Africa. One solution would be to mandate the requirement for discussion regarding a potential donor between the treating clinical team and a transplant team, and auditing the standard by which end-of-life discussions take place, ensuring that all families are provided with the opportunity to support organ donation. Public education regarding organ donation and transplantation and promotion among healthcare professionals to improve referrals should also be explored.

Another solution could be to implement a robust policy, such as the one implemented in Spain, the world leader in deceased organ donation, which is that of presumed consent. This involves the assumption that a patient provides informed consent to be an organ donor following the certification of his/her death, with the withdrawal of this consent required to be expressed in a clear statement.

Ultimately, organ donation and transplantation rely on the treating clinical team discussing a potential donor with the transplant team, and obtaining informed consent from a family deciding to support organ donation.

Authors:

Jomarie Weyers

Jormarie Weyers is a fifth-year medical student from the University of Pretoria. She is President of her local surgical society, the Tuks Student Surgical Society, Vice-President of the Southern African Student Surgical Society and the Administrative Officer of the International Association of Student Surgical Societies. She recently attended the 48th World Congress of Surgery as a part of the inaugural Future Surgeons Delegation.

Stephan Brink

Stephan Brink is a fifth-year medical student from the University of Pretoria. He is Vice-President of his local surgical society, the Tuks Student Surgical Society, and Editor-in-Chief of the International Association of Student Surgical Societies. He recently attended the 48th World Congress of Surgery as a part of the inaugural Future Surgeons Delegation.

Jomarie Weyers Stephan Brink

 

 

 

 

- Author Jomarie Weyers and Stephan Brink

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