World Kidney Day is marked each year on 12 March. In an opinion piece for the Weekend Argus, Prof Yazied Chothia from the Division of Nephrology writes that a kidney transplant is the best treatment for kidney failure because it gives patients the best chance of survival, a better quality of life, and is more cost-effective than dialysis.

• Read the original article below or click here for the piece as published.

Yazied Chothia*

On 12 March, we celebrate World Kidney Day. Around the world, about one in ten people have some form of chronic kidney disease (CKD). In South Africa, the main causes of CKD and kidney failure are high blood pressure, diabetes, and HIV infection. 

When kidneys fail, treatment options include dialysis—a procedure that cleans the blood—or a kidney transplant. In South Africa’s public hospitals, there are only a limited number of dialysis spots, so not everyone who needs it can get it. 

According to the latest South African Renal Registry report, 8,881 people are receiving treatment for kidney failure, which is just 145 people per million population overall. In the private sector, treatment is much higher at 720 per million, but in the public sector, it is much lower and declining over the past three decades, at only 44 per million. For many patients, dialysis is a temporary solution while waiting for a kidney transplant, which helps free up these spots for others who also need life-saving treatment.

A kidney transplant is the best treatment for kidney failure because it gives patients the best chance of survival, better quality of life, and is more cost-effective than dialysis. In South Africa, there are two main types of kidney transplants: one from a deceased donor and one from a living donor, who may be related or unrelated. Deceased donors are often people who have suffered irreversible brain damage, for example after a serious motor vehicle accident or a severe stroke. 

South African law considers a person legally dead when they have permanently lost all brain function, including the part that controls breathing and other basic life functions. The National Health Act 61 of 2003 recognises this as legal death, and doctors must follow strict guidelines and thorough testing before confirming it.

Anyone 18 or older can register as an organ donor. However, even if a deceased person is registered as an organ donor with the Organ Donor Foundation of South Africa, their family must still give final consent before organs can be donated South Africa has the potential to save many more lives through organ donation. 

In 2023, the country recorded 11,883 road deaths, according to the Department of Transport. Despite this, South Africa has one of the lowest organ donation rates in the world — fewer than 1 to 2 donors per million people. By comparison, Spain, a global leader in organ donation, achieves about 50 donors per million people. 

Low donation rates are due to several factors, including lack of awareness, cultural or religious beliefs, logistical challenges, and concerns about illegal organ trafficking. Interestingly, surveys show that 70% of South Africans are willing to donate, but when asked after a loved one dies, 82% of families refuse to give permission.

In 2019, my colleague Rafique Moosa reported that the number of kidney transplants in South Africa declined between 1991 and 2015. Most transplants—about 75%—took place in just two provinces, Gauteng and the Western Cape, and nearly 60% of donors were deceased. The decline in organ transplants was especially noticeable in the public health sector. 

According to Gauteng’s Health MEC, Nomantu Nkomo-Ralehoko, around 6,500 people are waiting for a life-saving organ transplant in South Africa, with 2,300 specifically waiting for a kidney. Yet, each year, fewer than 300 organ transplants are performed, most of them kidney transplants (around 250). 

Tragically, about 10% of patients on dialysis die each year while waiting for a kidney transplant, which means roughly 230 dialysis patients lose their lives annually due to the shortage. To put this in perspective, it is like a Boeing 737 crashing every year. 

So, how can South Africa improve organ donation and transplants? Experts suggest several key steps. Government involvement is crucial. In May 2025, the National Department of Health launched the DoNation campaign to boost organ and tissue donations. The campaign encourages people to register as donors and talk to their families about their wishes, helping to address the serious organ shortage. 

Other important measures include upgrading hospital facilities that handle transplants, training surgeons and transplant coordinators, changing public and healthcare worker attitudes, prioritising living donors, and even considering incentives for organ donation.

A great example of how better hospital facilities can help organ donation is Save7’s LifePod at Tygerberg Hospital. This is a special space where donors receive care, and families have a private area to say goodbye to their loved one. By the end of 2025, the LifePod had cared for its first donor, resulting in multiple organs being donated in over two years, thus saving seven lives!

In conclusion, South Africa has a proud history of organ transplantation, including the world’s first heart transplant in 1967 by Dr Christian Barnard, the first HIV-to-HIV kidney transplants, and the first penis transplant. Despite challenges that slow progress, we remain a leader in organ transplantation in sub-Saharan Africa. Yet too many patients still die while waiting for life-saving organs. South Africa, we can do better—let’s save more lives through organ donation!

*Professor Yazied Chothia is an associate professor and a medical specialist in the Division of Nephrology in the Faculty of Medicine and Health Sciences at Stellenbosch University.