A few years ago, in 2013, one of the leading medical surgeons in the field of kidney transplant, Dr E Muller, who works at Groote Schuur Academic Hospital in Cape Town, wrote on the Continuing Medical Education publication of the South African Medical Association, that South Africa has one of the highest incidents of people with chronic kidney failure in the world. He said there were about 5000 people who were living with Chronic Kidney disease, and about half of those people were awaiting kidney transplantation.
Dr Elmie Muller
Another medico, Dr Elmin Steyn, a past president of the South African Transplant Society and Surgeons, who works at the Chris Barnard Memorial Hospital in Cape Town, writing in a newsletter of the SA Transplant Society and Surgeons, said South Africa has one of the lowest organ donations in the world, at about 2-3 per million as compared to 13 per million in the United Kingdom, and 30 per million in Spain, the latter which is considered the most successful nation when it comes to organ donation.
It was further reported in the same article that, there are not enough organ transplants as compared to the population need. When the rate of transplants was compared between the public and private health sectors, the rate of organ transplants in the public health sector that covers almost 80% of the SA population, was found to be much lower than at the private health sector, which only covers a minority of the South African population. It was found that less than 30% of organ transplants in South Africa are done in the public health sector.
The overwhelming majority of people in the South African population are black people (Black Africans; Black Coloureds and Black Indians), and when one looks at the people who are the majority users of the public health sector, it is mainly the broader black population, by far. The level of awareness and acceptance of the concept of organ donation and transplant in this broader population group is relatively low, and it is therefore not surprising that the public health sector that they mainly use for their healthcare needs has relatively low levels of organs transplants. It was also reported that the organ donation consent rate in the private health sector was between 80-100%, as opposed to about 30% in the public health sector.
From the above information relating to organ donation and transplants in South Africa, the majority population group who are in most need of access to donated organs and transplant, are actually the least aware and willing to be organ donors to help solve the huge waiting lists for donor organs in the country, in both public and public health sector. There are many reasons behind the low consent rates for organ donation in the black population groups in South Africa.
The low levels of awareness about what organ donation is and what are its benefits most probably are the leading reason for the low consent rates. In addition to low organ donation awareness levels, there are also strong cultural and religious beliefs that are making people reluctant to donate or even accept donor organs from other people, especially from strangers.
It, therefore, stands to reason that for this low awareness and consent rates for organ donation to increase to meet the serious national need, there have to be national mass awareness campaigns to educate the target majority population about the whole concept of organ donation, and to deal with the cultural and religious beliefs, that may be stopping people who volunteering for organ donation or even accepting organ transplant.
When we talk about organ donation, we talk about donation of solid organs (kidneys; livers; heart; lungs; cornea; penis; skin etc.) from one person to the other, usually from deceased donors, although increasingly we are seeing more living donors coming to the fore, with all the risks that pose to their health during the transplant and post-transplant processes.
We are told that year on year, we are seeing declining numbers of deceased organ donations in South Africa, as such dying or dead people who could have helped to give a ‘gift of life’ to another living human being. These people who die without donating their organs go to their graves with their organs intact, which only serve to feed the ants in their graves, or have the organs being burnt through cremation.
In a way, people chose to die and be buried or be cremated with their organs that would have prolonged somebody else’s life, and to me if those people were aware of the benefits of organ donation to other living human beings, then I view that as a selfish act, certainly not in line with the Ubuntu values that most of us grew up with, which says “umntu ngumntu ngabanye abantu ’.
Personally, if I am made aware or my family is made aware that my death is imminent and inevitable, and no medical or other critical interventions can change that reality, then I would be happy to that through my death other people’s lives that depend on them getting my healthy organs get a second shot at a better life through a receiving my ‘gift of life’. To me that would be the ultimate selfless act, that would be in line with my Ubuntu value system.
In South Africa, Chronic Kidney Disease is the most common reason for people to require new kidney organ donation. In Chronic Kidney Disease, the kidneys that normally perform a number of bodily functions, especially filtration of the blood system and removal of excess water, waste, and other impurities, stop doing that effectively, and the resultant effect is that there is accumulation of excess water, waste and other impurities in the body, causing ill health to the sufferer.
The ill health amongst people who have Chronic Kidney Disease, presents with non-specific symptoms or nausea, vomiting, loss of appetite, fatigue, and weakness, sleep disorders, reduced mental sharpness, muscle twitches and cramps, swelling of the feet and ankles, persistent itching, shortness of breath and increased blood pressure.
Many of the people are stuck in the long waiting lists for kidney donation and transplant, and as a giving nation that we are, we must make it our business to help solve their life challenge, which literally is a ‘life and death’ matter to them, yet by being more aware and open to giving part of our being, should we be diagnosed with brain or even cardiac death, then we could give life to another human being. From a cost point of view, it is more cost effective and provides a much better quality of life for these patients than kidney dialysis.
Today, at the same time of publishing this article on organ donation on my health blog, I will also be publishing an article written by a friend of mine, Mr. Lulamile Morris Sidwaba who was recently diagnosed with Chronic Kidney Disease and is currently undergoing kidney dialysis three times a week, five hours per session, whilst awaiting a matching kidney donor. In his article, he gives a personal account of his journey that led him to be diagnosed with Chronic Kidney Disease, Kidney Haemodialysis, and being vetted for suitability to receive a donor kidney to provide a possible definitive solution to his life-threatening health challenge.
At my family level, an uncle of mine (Mr. Wilber Nyati) who is now in his mid-60s, was diagnosed with Chronic Kidney Disease in the mid-90s, and after a long wait for a suitable donor, he was eventually lucky enough to find a suitable kidney donor, which was not rejected by his body, and now more than 10 years later, he has a reasonably healthy life, thanks to the donor of that kidney, that made all the difference.
In conclusion, whilst most of my focus on this article was on solid organ donation, there are also other forms of donations of human products that are not solid organs, for example, Blood Donation. Whether it is a donation of solid body organs or it is for non-solid body products, the message is the same, in line with the Ubuntu values of the African people, let us bring that selflessness value into the major challenge of organ donations and transplants. Through awareness campaigns, we must deal effectively with our negative cultural superstitions or even religious teachings that may be making people be reluctant to donate organs or even accept donor organs.