A timeline of organ donation in South Africa. Graphic: Kenny Leung
Simonne Horwitz
“The most amazing thing in the world is to see that kidney taken out of one person and put into another — and then, when the artery and vein are connected and the kidney becomes pink and produces urine, that is like magic”. This is how one nurse, who has been working in the transplant unit at Charlotte Maxeke Johannesburg Academic Hospital for three decades, described a kidney transplant.
The first two such transplants in Johannesburg took place on August 25 1966, under the auspices of an academic team led by US-based transplant pioneer Prof Thomas Starzl and his South African counterpart Prof Bert Myburgh. Although the surgical procedures went according to plan, neither of the two transplant recipients survived long-term because of organ rejection. Rejection occurs when the transplant recipient’s immune system attacks the transplanted organ, and the medical profession was challenged with developing options to prevent rejection.
In the meantime, with rejection proving so problematic across the world, transplants were taking place between identical twins, or very closely related family members. People who got a “live donor transplant” had a much better survival rate than people who received organs from people they did not know or deceased donors. The first transplant in Johannesburg to have long-term success was done on January 11, 1968, during which the recipient received a kidney from his twin brother. He lived for 30 years with the new organ. The good success rates for transplant where donors were closely related helped medical specialists to understand cross-matching – where complex processes of blood and tissue testing could help to ensure that organs from one person would not be completely rejected by the body of another person. However, even when there was a close cross-match, the recipient would have to take anti-rejection drugs to try and stop rejection from occurring. These early drugs often had life-threatening side-effects and were only partially effective.
In spite of the challenges of rejection, developments in surgical skill, strict selection criteria, better understandings of immunosuppression and cross-matching meant that by the mid-1970s about 20 transplants were taking place in Johannesburg per year. And, in 1983, a new anti-rejection drug called cyclosporine came onto the market. The Johannesburg team began using the drug in 1984 and it dramatically improved long-term outcomes. Over the next decade, the team performed about 100 transplants a year.
However, significant changes occurred in the mid-1990s. After 1994 a major shift in health policy to a focus on primary health care diverted focus away from transplantation. Today, the practice faces significant resource challenges and declining donor numbers.