Transplantation in Africa - an overview.

Africa is underdeveloped in terms of treatment options for patients with end-stage renal failure. Economic growth and corresponding increases in health expenditures in the African region mean that we can confidently anticipate increased demand for organ transplantation within the region over the next few years. Renal failure in Africa occurs mainly due to glomerular nephropathies, hypertension, diabetes, and HIV. For the subset of the population that might be considered medically suitable for transplantation, demand for transplantation is tightly constrained by the availability of specialist physicians and surgeons, pathology facilities, capacity to achieve acceptable graft outcomes, cultural and religious attitudes towards organ donation, trust in the health system, and the extent to which patients are able to meet the costs of surgery and ongoing immunosuppression. There are currently several countries in Africa which are building up living-related-donor transplantation. Active living-donor transplantation already takes place in South Africa, Tunisia, and Sudan, but deceased donation is only available in South Africa. Whereas living-donor transplantation might be successfully driven by a motivated individual and a single institution, deceased-donor transplantation requires dialysis programs, tissue typing and crossmatching facilities, an organ procurement program, an on-call surgical team, capacity to fund this infrastructure, and an appropriate legislative framework. A significant and recurring barrier to transplantation in the African region is the high cost of transplantation and follow-up care, and, in particular, the cost of maintenance immunosuppression. A positive environment that could potentially change this scenario will have to include governmental funding, academic support to clinicians as well as a legislative framework, which is still needed in many African countries.