Deceased donor organ transplantation: A single center experience from Cape Town, South Africa

Introduction

Renal transplantation (RTx) is the best therapeutic modality for patient suffering from end stage renal disease (ESRD). In the public sector hospitals in South Africa, dialysis is limited and patients need to be selected carefully for these programs. Deceased donor organ transplantation (DDOT) accounts for approximately 60% of renal transplants at Groote Schuur Hospital, Cape Town, South Africa. It is our aim to increase deceased donation, despite socioeconomical difficulties.

Materials and Methods

This was a retrospective review of deceased donation at Groote Schuur Hospital between January 1996 and December 2005. In this period we received between 60 and 113 referrals per year for brain-dead organ donors [Table 1]. We employ two transplant coordinators who work full time at the hospital. Referrals are from our own hospital, as well as from peripheral hospitals in our area. We also get referrals form hospitals in the Eastern and Northern Cape.

Table 1 Donor referrals between January 1996 and December 2005

Results

Donor demographics

In this time period, 321 donors were black, 154 white, 318 mixed race and 30 unrecorded. The average age of donors were 26.15 years. This is the result of high trauma death rates in South Africa, which mostly involves younger people. Interestingly, only 39% of donors had O blood group and 38% A blood group. The rest were divided between 18% B blood group and 5% AB [Table 2].

Table 2 Donor demographics

Organ utilization

Referral rates do not correlate to utilized donor rates. This is a result of numerous factors. Consent remains a major problem as a lot of our patients comes from uneducated backgrounds and has religious and social issues with organ donation. Finding the family might also proof difficult, as contact details are not always readily available [Table 3].

Table 3 Reasons organs not utilized

Cause of death

South Africa has a high trauma rate and for this reason most of our donors come form the Trauma unit at Groote Schuur Hospital. Medical donors remain a small part of our total donors [Table 4].

Table 4 Cause of death

Discussion

Deceased organ donation in South Africa between 1996 and 2005 had room for improvement in many aspects. Consent rates needs to be improved and this is currently being addressed with Transplant coordinator workshops and education, co-funded by the South African Transplantation Society and the Organ Donor Foundation. Public education remains a major priority in South Africa. At Groote Schuur Hospital a Donation after Cardiac Death programme was started after the results of this study had been noted. Successful utilization of the donors who had a cardiac arrest after brain death certification would have resulted in an 11% increase in organ utilization rate. Infections in donors were mostly HIV, active Hepatitis B and bacterial infections. This had recently been addressed by starting a HIV positive donor to HIV positive recipient program.[1]

Conclusion

Deceased donation forms the cornerstone of renal transplantation in Cape Town. However, it is clear from these results that a lot of problems still need to be addressed. In a large tertiary hospital, receiving referrals for trauma, neurosurgery, and medicine, referral rates remain low. This is probably a result of poor education to medical doctors regarding organ donation. Public attitudes toward organ donation remain problematic and poor consent rates should be improved with better education and training to the public.