The reality of kidney transplants in South Africa

The process to get a transplant of any kind is quite a complicated process, which is unsurprising! One community member shared her story of life after a kidney and pancreas transplant, but she was one of the lucky ones. Keep reading to get the full picture about what the process of receiving a transplant in South Africa is actually like.

How does the organ donation process work?

We spoke to Samantha  from the Organ Donor Foundation (https://odf.org.za/) to understand how organ donations and transplants work.

All organ donation is extremely time-sensitive; organs must be retrieved and transplanted within hours to remain viable. This requires detailed coordination between hospitals, transplant teams, and transplant coordinators to ensure that organs reach recipients in time and are successfully transplanted. 

This is quite a complex process that can be summarised as follows: 

• A person is declared brain-dead by two independent doctors.
• If they are a potential donor, the family is approached by a transplant coordinator.
• Consent is obtained, and organs are matched to recipients.
• Organs are surgically removed and transported to the transplant centres according to the match.
• Transplantation is performed within hours (organs are only viable for a few hours after removal).
• Tissue removal can take place several hours or days after death.

The Organ Donor Foundation (ODF) encourages everyone to register (even people with diabetes!). The decision if organs or tissue will be used will be made by medical professionals at the time of death. There is no age limit to register as an organ donor. 

Can living people donate organs, and what does that process involve?

Yes. Living donors can donate:

• One kidney.
• A portion of their liver (normally from adult or parent to a child and not as common as living kidney transplants).

The process for a kidney transplant from a living donor involves:

• The donor and recipient are evaluated at a transplant centre (includes medical, psychological, and compatibility testing).
• Donors must be healthy with no significant risk factors (e.g., high blood pressure or diabetes).
• Informed consent is obtained — donation is voluntary and cannot involve payment.
• Legal and ethical approval is required (submitted to the Minister of Health for approval in South Africa).
• The surgery is scheduled at an approved transplant hospital.
• The donor undergoes nephrectomy (surgical removal of one kidney).
• The recipient receives the kidney in a separate operating theatre.
• Both donor and recipient receive aftercare and follow-up support.
• Donors can live healthy lives with one kidney.

What medical conditions disqualify someone from being an organ donor?

While diabetes and high blood pressure may affect a living donor’s eligibility to donate an organ, some medical conditions disqualify someone from being an organ donor.

There is an important distinction between registering as an organ donor after death and being assessed for living organ donation. 

The Organ Donor Foundation encourages everyone to register and leave the decision up to medical professionals to decide if someone is a suitable donor. When someone registers as an organ donor, their medical suitability is assessed if and when donation becomes possible. Conditions like active cancer, uncontrolled infections, or HIV (in some cases) may disqualify a person. However, each case is assessed individually. HIV-positive donors may donate to HIV-positive recipients.

For living donation, however, the criteria are much more stringent because the donor is a healthy person undergoing surgery, and their safety is the primary consideration.

1. Registering as an organ donor after death

Anyone can register their intention to become an organ donor, regardless of their age or whether they have a particular medical condition. Registering does not mean that the person will necessarily be able to donate their organs.

If a registered donor dies in circumstances where organ donation may be possible, the medical team will assess the person at the time of death. The relevant specialists will determine which organs, if any, are medically suitable for transplantation. 

Therefore, conditions such as diabetes or high blood pressure do not necessarily prevent someone from registering as an organ donor.

This is why we generally encourage people to register their decision to donate rather than trying to determine themselves whether they are medically suitable.

2. Living organ donation

Living donation is different. A person wishing to donate an organ, such as a kidney, undergoes a comprehensive medical and psychological assessment before they can be approved as a donor.

Conditions such as diabetes and hypertension (high blood pressure) are therefore considered as part of that assessment. It is not simply a case of whether someone has ever had the condition — the medical team will consider the individual’s overall health, the condition itself, whether it is controlled, kidney function and other relevant risk factors. The final decision is made by the transplant team following the appropriate medical assessment.

What are the most common misconceptions about organ donation that you encounter, and how do you address them?

Common myths include:

MYTH: There is a cost involved in registering as a donor.  

FACT: There is no cost to register as a donor – it is completely free. 

MYTH: It is a complicated process to register and you need to undergo tests.  

FACT: It is a simple sign up process and only takes a few minutes of your time. You do not need to undergo any tests – this is only done at the time of your death and if you are a suitable candidate for organ/tissue donation. You can register online at www.odf.org.za or call the ODF Toll Free line (0800 22 66 11). 

MYTH: Doctors won’t try to save your life if they know you are a registered donor.  

FACT: Doctors and medical staff are trained to do everything possible to save your life — it is their top priority, regardless of whether you are an organ donor or not. In fact, the team that works to save your life is completely separate from the transplant team. 

Only once all life-saving efforts have failed and a person is declared brain-dead by two independent doctors (following strict medical and legal guidelines), will the possibility of organ donation even be considered.  Your status as an organ donor has no influence on the care you receive.

MYTH: Your body is disfigured or your funeral is delayed 

FACT: Organ and tissue donation is carried out with great care and respect by trained medical professionals. The body is not disfigured in any way. The donor’s body is treated with dignity throughout the process and does not prevent an open-casket or traditional funeral. If the body needs to be buried within a specific time frame, the medical team will make every effort to ensure the timeline is respected.

What are the current organ donation statistics in South Africa?

Fewer than 1% of eligible South Africans are registered as organ donors. There are less than 100 actual organ donors per year. This is less than 1.6 donors per million population, which is the lowest in the world. 

Approximately 4,300 people, including both adults and children, are on waiting lists for an organ – the majority are waiting for kidneys. 

There are less than 300 organ transplants performed each year. Public awareness, education and family conversations are crucial to changing this.

What is the average waiting time for a kidney transplant?

The average waiting time for a kidney (if the person does not have a living donor) can be anything from 5 to 12 years. The other solid organs vary according to urgency and donor to recipient compatibility. Sadly, a great number of these patients die, because they do not receive an organ in time.  

Which organs and tissues are most urgently needed?

All organs and tissues are urgently needed, but the greatest demand for organs is kidneys, as they make up the largest portion of patients on the transplant waiting list.

Kidney patients receive dialysis, which temporarily replaces the function of the kidneys. However, for patients needing other organs – such as hearts, livers, or lungs – there are very few or no alternative treatment options. Without a transplant in time, these patients may not survive. Skin is desperately needed for burns patients and is life-saving.  

How do cultural or religious beliefs impact organ donation rates?

Cultural and religious misconceptions 

Many individuals mistakenly believe that their cultural or religious beliefs do not support organ and tissue donation. In some cases, culture or religion is used to shut down the conversation altogether.

Religious support

In reality, most major religions in South Africa support organ and tissue donation, viewing it as a final act of compassion, generosity, and saving lives.

What role does education play?

These misconceptions can only be overcome through respectful dialogue and targeted education that engages both community leaders and the public.

What do organ recipients typically share about their experience?

Recipients often describe the gift as a second chance at life. Many are deeply grateful and choose to advocate for donor awareness, expressing hope, humility, and deep appreciation for the donor families.

How can people register to become organ donors?

You can register online at www.odf.org.za or call the ODF Toll Free line (0800 22 66 11).