Tackling the crisis of organ donation in SA

Posted on 12 November 2019

The innovative Wits Transplant Procurement Model shows promise in increasing deceased organ donor numbers in South Africa.

Only 0.2% of South Africans are registered organ donors, according to statistics collected by the Organ Donor Foundation of SA. This shortage places an enormous burden on hospitals across the country, resulting in significant surgical backlogs, and severely compromising the quality of life of patients who require organ, tissue or cornea transplants.

In 2016, Mediclinic’s Wits Donald Gordon Medical Centre embarked on a bold new strategy to increase the number of registered deceased organ donors in the greater Johannesburg area – and it is already showing promising results.

“It’s no secret that South Africa has an extreme shortage of organ donors,” says Dr Harriet Etheredge, a medical bioethicist and health communication specialist at the hospital, who has a particular interest in ethical and communicative challenges across highly specialised medical settings. “But we felt there must be something we could do about that. First, we could increase potential donor referrals, and secondly, we could work on how we approach our patients to ask for their consent.”

One does not work without the other, she explains. Wits Donald Gordon Medical Centre (WDGMC), the first private academic hospital in South Africa, is a referral hospital, where patients are sent to see specialists after consultation with external doctors. Before doctors could approach family members of qualifying patients, they first had to increase the number of patients referred to the hospital.

“To be an organ donor in South Africa, a patient has to be declared brain stem dead,” Dr Etheredge says. The term brain stem death refers to a person who no longer has any brain stem functions – they have permanently lost the potential for consciousness and the capacity to breathe. In a hospital setting, this patient’s heart is kept beating by means of a ventilator.

These patients have had major traumatic injuries, she says, particularly to the head. “These patients have no cerebral function. Unfortunately there is no coming back from that; there is no chance of a miracle. But what they can do is donate their healthy organs.”

WDGMC doctors provide educational talks at a catchment area of referral hospitals. “When staff members at these hospitals recognise brain stem death in a patient, they are then empowered to call our coordinator to take over the medical management of that patient.”

Which organs are needed exactly? Dr Etheredge says that in SA, patients in need of healthy kidneys wait for donations longer than most. “This is because they can be placed on dialysis if needed, and live much longer. So really, there is no one organ we need more than another,” she explains. “We need any organ that anyone is willing to donate, from their deceased family member.”

One full organ donor could potentially save seven lives. Kidneys, lungs, the liver – all of these play vital, life-saving roles in a hospital setting. “When the family of an organ donor gives consent,” she says, “they may stipulate that we use only a few, or all, of the viable organs or tissue. They are in control.”

This project is known as the Wits Transplant Procurement Model, and the preliminary results were published in a report, “Increasing deceased organ donor numbers in Johannesburg, South Africa: 18-month results of the Wits Transplant Procurement Model”, in the South African Medical Journal, Vol 109, No 9 (2019).

Since the initiation of this model, the hospital’s referral numbers from targeted hospitals increased by 54% – and patient consent rate has jumped from 25% to 73%.

“This is a learning process,” says Etheredge, “and we are always adapting our approach. But we are confident that this strategy is leading to good results. The key is approaching families in the right way: we must be empathetic, and inform and empower them enough in order to enable responsible decisions around organ donation.”