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Annals of African Medicine, Vol. 10, No. 2, April-June, 2011, pp. 131-132 Commentary Editorial on live donor renal transplantation in South Africa Kasonde Bowa University Teaching Hospital, University of Zambia School of Medicine, Zambia Correspondence Address: Kasonde Bowa University Teaching Hospital, University of Zambia School of Medicine Zambia kbowa@yahoo.com Code Number: am11026 DOI: 10.4103/1596-3519.82079 End-stage renal disease (ESRD) is a major problem in sub-Saharan Africa. ESRD is the main indication for renal replacement therapy (RRT). Chronic renal dialysis provides palliation and serves to ameliorate symptoms for the patient while awaiting RRT. RRT or renal transplant can be done from a live donor (live donor transplant) or from salvaged kidney from a deceased donor (cadaveric transplantation). Live donor transplant provides a better survival rate for the graft and a better overall outcome. The high demand for RRT has resulted in an increase in live donor transplants as the number of cadaveric kidneys have been unable to meet this increasing demand for kidneys. [1] ESRD is three to four times more common in Africa than in the developed countries. There are no reliable statistics in Africa. However, it appears that glomerulonephritides, hypertension, and diabetes represent three of the main causes of ESRD. This condition has been compounded by the advent of HIV-related nephropathies in much of sub-Saharan Africa. The cultural and social taboos related to the community perception of death, life, disease, operation, and organ transplantation in Africa promote a rather negative attitude to live donor transplantation. [2] The article on living donor transplantation in south Africa has great relevance in this context. The study shows a high rate of withdrawal of potential live donors (59.7%) and almost one-third (29%) for nonmedical reasons. Epidemiology Review The prevalence of chronic renal failure in Africa is not well document but has been stated as anywhere between 3 to 8% of the population. It is estimated that 2 to 3% of medical admissions are due to renal disease in tropical Africa. According to the South Africa Transplant and Dialysis Registry, 52.1% of ESRD is due to glomerulonephritides and 45.6% due to hypertensive disease. The annual demand for RRT exceeds the supply by 75%; the waiting list for RRT has continued to increase over the last 10 years. The live donor transplantation comprises only about 30% of the transplants done. [1],[2] Clinical Review The presence of chronic dialysis services and renal transplant is low in Africa, with the exception of North Africa and South Africa; very few centers exist in sub-Saharan Africa for RRT. The current estimate for dialysis ranges from 70 per million populations in South Africa to under 20 per million populations in most of sub-Saharan Africa. In many sub-saharan African countries these services donot exist. The transplant rate in most of Africa averages four per million while in South Africa it averages 9.2 per million. The services are also mostly available in urban centers and tend to be available to the more educated urban populations. The role for Africa should be to increase the number of dialysis and transplant centers, increase the number of live and cadaveric donors, and improve the preventive programs for renal disease. [1],[2] Attitudes towards live donor transplants The literacy and numeracy rates in much of sub-Saharan Africa is low ranging from 25 to 75%. [3] This means that there is little knowledge of renal disease, ESRD, and current high technology treatment such as renal transplant. Many religious and traditional beliefs may impact negatively the willingness of a person to be a live kidney donor. In addition the fact that many of these services are only accessible in urban areas make them difficult and inaccessible to the majority of the communities in Africa. [3],[4] Conclusion Renal disease is an increasing and common disease in Africa. The existence of renal support services such as dialysis and renal transplant services across Africa is very low. Although there is an increase of live donor transplantation worldwide, there is a low willingness to provide kidneys in many African populations. The low literacy levels, low urbanizations, high influence of family, and culture may prove a barrier to the development of these programs in Africa. However, countries must undertake aggressive programs of community sensitizations to create and promote these services in Africa because of the high burden of renal disease in Africa. References
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