’Correspondence
The unmet need of organ transplantation in Africa
Wireko A. Awuah, MBBSa, Jyi Cheng Ng, MDb, Halil I. Bulut, MDc, Abubakar Nazir, MDd,
Pearl O. Tenkorang, MBChBe, Rohan Yarlagadda, BSf, Mubarak J. Mustapha, MBBSg,
Tou k Abdul-Rahman, MBBSafi , Aymar Akilimali, MDg,*, Victor N. Oti, MDi, Narjiss Aji, MDj
Dear Editor, function depended heavily on government backing. While
Africa, a promising continent with a population of over 1.2 numerous participating countries identified that there are no
billion people, faces a massive disease burden due to their fragile satisfying or detailed regulations in place, Ghana and Nigeria
healthcare systems. The prevalence of diseases in Africa, parti- indicated, however, that medical practitioners are presently
cularly noncommunicable diseases is rapidly increasing and, if advocating authorities to enact transplantation laws[2]. In
not controlled, can have a negative impact on the continent, given Nigeria, there are progressive efforts made by surgeons to
the challenges Africa already faces. Noncommunicable diseases establish a liver transplant center in their hospital. One of these
cause most end-stage organ failures worldwide and are the initiatives includes a yearly conference which explores obstacles
leading cause of death, accounting for 71% of global deaths and each doctor faces when doing transplants and to devise a strategy
85% of deaths in low- and middle-income countries[1]. Organ for overcoming those obstacles[3]. To establish a transplantation
transplantation, one of modern medicine’s breakthroughs, has registry and train its staff in all liver transplant specialists, the
been clinically successful in treating end-stage organ failure. same hospital has started a bilateral partnership with a liver
Unfortunately, just a few states are offering organ transplants in transplant center in Malaysia and Turkey[3].
Africa, which include Ivory Coast, South Africa, Seychelles, In the context of global efforts, there are resolutions made by
Sudan, Nigeria, Namibia, Kenya, Ethiopia, Ghana, Mauritius, the World Health Assembly (WHA) and guidelines by the WHO
and Tanzania. Surprisingly, only 643 organ transplants were to regulate all forms of transplantation. The WHO has set up a
recorded in Africa in 2016[1]. task force to ensure proper care is delivered globally which will
Although Africa lags behind other regions in terms of trans- benefit Africa as well[1].
plantation capacity, there has been significant progress in the past Nevertheless, Africa faces major setbacks in organ transplant
decades. Initiatives have been implemented to boost the under- services. An example of these setbacks is insufficient transplant
standing of transplant surgeries. For instance, in 2013, South facilities. For example, only seven African states including
Africa invited 10 countries (Cameroon, Ethiopia, Ghana, Kenya, Algeria, Côte d’Ivoire, Ethiopia, Kenya, Namibia, Nigeria, and
Malawi, Nigeria, Rwanda, Senegal, Sudan, Tunisia, andZambia) Uganda have facilities for kidney transplantation. In fact, the
for a Global Alliance on Transplantation meeting with the aim of entire African continent has just 35 centers for kidney trans-
equipping them with the needed skills and knowledge for organ plantation. Uganda and Namibia have only one heart transplant
transplantation[2]. Also, the creation of an acceptable declaration center each. Tissue typing, cross-matching, and some viral stu-
where organ donation and transplantation programs can dies, which are major aspects of patient preparation, are mostly
done overseas delaying the procedure and increasing the cost of
aSumy State University, Sumy, Ukraine, bFaculty of Medicine and Health Sciences, transplantation. Adequate histological evaluation of biopsy spe-
University of Putra Malaysia, Serdang, Malaysia, cIstanbul University Cerrahpasa, cimens is largely unavailable, making prompt management of
Cerrahpasa School of Medicine, Istanbul, Turkey, dKing Edward Medical University, rejections and infections problematic[2].
Lahore, Pakistan, eUniversity of Ghana Medical School, Accra, Ghana, fRowan
University School of Osteopathic Medicine, Stratford, New Jersey, USA, gFaculty of Besides, poor infrastructure, lack of institutional support and
[3]
Basic Medical Sciences, University of Ilorin, Ilorin, Nigeria, hFaculty of Medicine, technical skills like human resources aggravate the challenges .
Official University of Bukavu, Bukavu, Democratic Republic of the Congo, iKyiv Lack of financial protection and insufficient national and inter-
Medical University, Polish Campus, Ukraine and jFaculty of Medicine and Pharmacy national funding halt the progress in organ transplantation and
of Rabat, Mohamed V University, Rabat, Morocco
availability of immunosuppressive therapies[3]. For example, only
W.A.A and J.C.N contributed equally and are joint first authors. Algeria provides facilities of free immunosuppressive therapies to
This manuscript has been peer reviewed. the recipients. The inflated cost of organ transplants and post-
Sponsorships or competing interests that may be relevant to content are disclosed at operative therapies along with insufficient financial support in
the end of this article.
many states contribute to the challenges associated with organ
*Corresponding author. AddressBagira Kagera rue 16, Bukavu, South Kivu, 570, DR transplantation[3].
Congo. Tel: + 243825177370. E-mail address: aymarakilimali@gmail.com
(A. Akilimali). Skilled workforce is the cornerstone of the healthcare system of
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. This is an every country. Organ transplantation includes close coordination
open access article distributed under the Creative Commons Attribution License 4.0 of health professionals including transplant surgeons, nephrolo-
(CCBY), which permits unrestricted use, distribution, and reproduction in any gists, pathologists, and skilled nurses. In African countries, there
medium, provided the original work is properly cited. is an extreme shortage of healthcare workers. There are only 2.3
International Journal of Surgery (2023) 109:519–520 healthcare workers for every 1000 persons available in Africa,
Received 21 November 2022; Accepted 28 November 2022 whereas developed countries like America have 24.8 healthcare
Published online 24 March 2023 workers per 1000 individuals[4]. Of 47 countries in sub-Saharan
http://dx.doi.org/10.1097/JS9.0000000000000025 Africa, only 15 countries have data regarding nephrologists.
519
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Correspondence. International Journal of Surgery (2023) International Journal of Surgery
There is a paucity of data regarding the number of surgeons, transparency. In addition, each African country should set up its
particularly transplant surgeons on the African continent. Lack of own national transplant registry in accordance with the recom-
opportunities, uncertainty in employment, and poor financial mendations by the WHO Regional Committee for Africa.
conditions have resulted in brain drain of African highly skilled
workers to the developed countries[5].
The global increase in organ failure has spiralled the demand Ethical approval
for organ donors, particularly in Africa. Given the enormous Not applicable.
burden of organ failure on the African continent already, as well
as the medical management costs associated with this burden,
organ transplantation is both economically and medically Sources of funding
necessary. However, as in the rest of the world, there is a scarcity
of donors, particularly cadaver donors in Africa. For example, None.
only three countries in sub-Saharan Africa; Nigeria, Kenya, and
South Africa, have a functioning kidney transplant program with Authors’ contribution
only South Africa performing cadaver transplants[6]. Religious
and cultural beliefs play a significant role in Africa’s donor W.A.A. and H.I.B.: conceptualized the ideas. J.C.N., R.Y., P.O.
shortage. There are superstitions about organ transplantation, T., and W.A.A.: reviewed and edited the manuscript. All authors
which can only be corrected through awareness and enlight- were involved in data curation, writing of initial draft, and
enment campaigns[7]. These sociocultural beliefs impede organ final draft.
harvesting from people who have been medically declared to be
dying. Other than that, the problem of illiteracy is more common
in Africa, limiting the awareness and education on the potential Conflicts of interest disclosure
possibilities of organ donation[8]. As a result, we can summarize The authors declare that they have no financial conflict of interest
the donor problems as a lack of public awareness and education with regard to the content of this report.
on organ donation, widespread infectious diseases, and lack of
active transplant centers.
Due to the poor situation with organ transplantation in Africa, Research registration unique identifying number
effective measures have to be taken to combat issues faced with (UIN)
organ transplantation to strengthen the healthcare system and
reduce disease burden. There is a need to expand the current Not applicable.
capacity of organ transplantation services in Africa by increasing
transplant centers and upgrading already existing transplant
facilities and infrastructure. Pretransplantation and post- Guarantor
transplantation services should be established in Africa to reduce Wireko A. Awuah.
the need to rely on overseas services and to improve cost-effec-
tiveness. African governments should also consider a national
insurance scheme to reduce the cost of organ transplantation Acknowledgements
services and relieve the financial burden of their citizens.
Furthermore, Africa should also build up their organ trans- The authors acknowledge the ICORMEDCollaborative Research
plantation workforce involving a multidisciplinary team which Group for coming up with this project.
consists of transplant surgeons, transplant physicians, pharma-
cist, social worker, dietitian, counsellor and a clinical coordi- References
nator. Transplant education and training programs should be
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