Disparity in organ distribution in Gauteng province in South Africa: Challenges and solutions

Background Despite South Africa's rich heritage as pioneers in organ transplantation, access to organs remains a major issue in the Gauteng province. This is secondary to an array of socioeconomic and political factors that have implications for organ distribution. Our aim was to assess the contribution of the public sector to solid organ transplantation in Gauteng province and compare the distribution of solid organs between the recipient groups.Methods This was a retrospective registry review of consented brain-dead donors from the public sector within Gauteng from January 1, 2016, to June 30, 2021, coordinated at Charlotte Maxeke Johannesburg Academic Hospital, a tertiary academic hospital.Results Records of 49 deceased donors were analyzed. Mean donor age was 31.5 years with the age group 30-39 years constituting the majority of deceased donors at 15/49 (30.6%); 10/49 (16%) were from pediatric donors. There was a significant discrepancy in allocation between public and private sector in cardiac (p = .012) and liver allocation (p < .001) and adult and pediatric recipients for all solid organs (p < .001). There was a significant increase in the rate and number (p = .0026) of pediatric kidney transplants occurring after March 1, 2020, when there was a transition to a public sector-mandated kidney transplant waitlist.Conclusion Current disparities in organ distribution have a significant impact on public sector recipients, especially pediatric patients. This is likely secondary to paucity of legislation and resource limitations which would benefit from improved governmental policies and explicit pediatric prioritization policies in transplant units.