Organ donation refers to the transfer of a healthy and viable organ or tissue from a donor to a recipient whose organ has failed or is no longer functioning adequately.
In this sense, donation is the deliberate act of giving that makes transplantation possible and, consequently, can provide a recipient with a chance of survival.
What makes it so crucial is that these organs are indispensable. Therefore, the availability of viable organs remains critical to ensuring the success of this procedure.
Depending on the circumstances, either a living or deceased donor can provide an organ or tissue.
A living donor may donate certain organs or parts of organs while remaining alive. For instance, a suitable donor may give one kidney or part of the liver and, in specific circumstances, part of a lung or pancreas.
In contrast, after a person has died, medical professionals may recover organs and tissues for transplantation from deceased donors.
That said, deceased donors provide only heart valves, hearts, and corneas. This enables surgeons to procure organs such as the heart, which cannot ordinarily be donated by a living person, as well as other organs and tissues that may be suitable for transplantation.
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Why Organ Donation?
In the past 71 years, on December 23, 1954, doctors performed a modern alternative to treat irreversible end-stage heart failure.
Before this time, a diagnosis stating organ failure or damage literally meant a death sentence. Consequently, this has led to thousands of irreversible losses hinged on the limitations of conventional treatments.
However, the huge success of this procedure depends on more than just medical advancement. At its core, it relies heavily on two fundamental human values: fairness and empathy.
Through the generosity of a living or deceased donor, a second chance at life becomes feasible. Also, the demand for transplants has steadily increased due to the prevalence of chronic disease.
The World Health Organization (WHO) reports that healthcare systems meet only 10% of the need for organ transplantation each year. Ever since, the growing demand has far exceeded the availability of viable organs, raising the question:
Why does the gap in organ donation still exist?
Data play a crucial role in explaining the existing gap. In the United States, 12 people die each year waiting for an organ transplant, while the national waiting list gains a new patient every 8 minutes.
Globally, Africa recorded only 286 organ transplants in 2022, far behind the Americas (62,153), Europe (40,337), and the Western Pacific (29,014).
More strikingly, Africa reported no deceased-donor organ donations in 2022, except in South Africa. The only country on the continent with policies allowing deceased-donor transplants.
In terms of infrastructure, the African region has just one heart transplant centre per 285 million people. One lung center per 570 million people, compared with one heart center per 3.5 million and one lung center per 9 million in the Americas.
The first successful human heart transplant in South Africa in 1967 marked a defining moment in medical history. Given the attention it received, it is worth asking why this breakthrough did not lead to a comparable expansion of organ donation and transplantation across Africa.
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What drives the persistent gaps in organ donation?
Economic & Infrastructural Barriers
This is the leading challenge in bridging the barrier posed by the paucity of organ availability. It includes socioeconomic disparities and infrastructural barriers.
Socioeconomic disparities include financial constraints, limited access to healthcare, and geographic location. The infrastructural barrier also hinders the sustainability of successful and reassuring organ transplants in Africa.
For instance, the costs of transplants in Nigeria and other African countries range from $10,000 to $50,000. This alone creates a stratum that further widens the gap between the rich and the poor.
Furthermore, it does not end with a one-time payment for the surgical procedure. It includes the lifelong cost of immunosuppressant drugs, which range from $800 to $1,200 without health insurance.
For an average African earning below $200 monthly, this becomes an unending cycle of loans and financial burden.
This explains why, when patients are diagnosed with chronic organ failure, they resort to faith-based interventions or depend on fundraising from family, friends, and social media networks.
A 2021 Ugandan report reveals that the high cost of heart transplants creates an overwhelming financial barrier for both patients and medical facilities.
As it stands, poverty and lack of proper infrastructure stand tall in opposing access to organ donation in Africa, characterized by economic failure and meagre infrastructure.
Cultural and Religious Misconceptions
Culture and beliefs are the elements that shape our lives and values and sometimes determine our trajectory. It also influences how we interpret the phase of life called death and the afterlife.
Contrary to popular belief, most major Christian denominations, including the Roman Catholic Church, the Anglican Communion, and many Pentecostal churches. They view organ donation as an act of charity, compassion, and love for one’s neighbour.
Belief in the rapture comforts Christians, who expect their loved ones to rise just as Jesus Christ did. This belief offers solace after a loss.
However, it changes the lens through which they see the dead. Hence, the removal of organs and tissue becomes a highly resisted consensus, and this also heightens the respect accorded to the dead.
Islamic traditions further limit the acceptance of organ donation because Islamic law requires burial within 24 hours of death.
Within this strict window, families must perform vital rituals, including bathing the body, reciting prayers, closing the deceased’s eyes, straightening the limbs, and tying the jaw shut.
These sacred rites interfere with the timely procedure. Given the time needed to mourn and to exercise necessary rights, organs such as the heart and lungs would have started deteriorating.
Traditional beliefs often emphasise reincarnation, holding that the deceased return across generations through shared physical traits or distinct personality characteristics.
Babatunde: In Yoruba, the name means the father has returned, given to a male child born after the death of a grandfather or father
Nnanna: In the Igbo culture, it means the father’s father, or “grandfather”, given to a boy thought to be the reincarnation of his grandfather.
Ababio: In Ghana, this name refers to someone who has returned, given to a child born after others in the family have died, to show that the child keeps returning.
Isithunzi: In South Africa, the name refers to a child who shows an undeniable physical or behavioral resemblance to a departed elder, and thus bears the exact name of the deceased.
The names above and other widely known names signify the weight of deeply rooted belief and correspond to highly moral respect for the dead and also the need to keep organs intact for proper representation in the next life.
In some South African communities, maintaining bodily wholeness after death is essential for spiritual continuity. Death is not an end; rather, a transition to the ancestral realm.
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Myths and Misconceptions
Hypothetical concerns, assumptions, and unfounded fears often deter individuals from considering organ donation. Furthermore, the rise of illicit organ trafficking fuels these pervasive misconceptions and myths. Among the most common concerns are:
Myth #1: Doctors will not work as hard to save your life if you are an organ donor.
Fact: Hospitals treat every sick patient regardless of their organ donor status. Medical teams only request donation status after certifying brain death, using an entirely separate team of doctors from the patient’s primary care physicians. If donation topics arise earlier, the hospital brings in an independent entity to manage the conversation.
Myth #2: Brain death does not necessarily mean death.
Facts: Brain death completely and irreversibly destroys all brain function, stripping the organ of its ability to control vital processes like breathing and permanently erasing consciousness. Under this strict medical standard, can medical teams proceed with a transplant if the patient or family has already granted consent?
Myth #3: I’m too old to be an organ donor.
Fact: There is no age limit to organ donation; what is most important is the overall health and the condition of the organs of the person in question.
However, where a person has not attained the age of eighteen years, they may not have legal capacity to give valid consent with respect to organ donation after death.
Myth #4: You can’t have an open casket funeral after organ donation
Fact: The transplant teams exercise great care and caution to ensure there are no signs, or without leaving signs or scars of organ or tissue donation.
Myth #5: Rich or famous people get priority for organs.
Fact: Priority is based mainly on factors like blood type, tissue match, urgency, and time spent on the national wait list. While many people harbor this fear, strict legal frameworks ensure that medical teams allocate organs solely based on patient compatibility, completely ignoring fame or celebrity status.
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The Role of Grief in Organ Donation Decisions
One of the primary causes of refusal of organ donation, especially after death, is the emotional rush at the spur of the moment. Learning the irreversible truth puts family members at the earliest stage of grief, which is denial.
At this point, a fragile sense of hope often remains. During burial, loved ones may continue to perceive the deceased not merely as a body, but as someone whose life and presence remain deeply significant.
Consequently, families find consenting to organ donation exceptionally difficult because they view the choice as a final step that shatters all hope of a miraculous recovery.
In this light, the topic of organ donation is not worthy of consideration. Families often view even a suggestion of donation as a sign that medical professionals have given up on the patient.
A case study carried out in different hospitals in South Africa reveals scenarios where family members turn down a transplant for several reasons, of which religious reasons are more prevalent.
It is now a matter of logic versus emotion, and the time required to blur the line between them is highly detrimental to the time-conscious surgical procedure.
Grief is a powerful and valid barrier to donation. In some cases, knowing the deceased had in writing approved donating their organs or tissue, the success rate rose to 90% compared to the mere suggestion of intent.
Laws and Policy Regulating Organ Donation
South Africa’s National Health Act No. 61 of 2003 strictly regulates organ donation, enforcing severe consequences to prevent fraud.
Specifically, Chapter 3 prohibits any organ transplant without written approval from the Minister of Health, unless the donor and recipient share a genetic relationship.
Furthermore, Section 60 criminalises any monetary gain from organ or tissue donation. In a major scandal, authorities caught a South African medical facility falsifying documents to present unrelated donors and recipients as siblings just to bypass these strict Chapter 3 restrictions.
The facility also offered poor Brazilian donors $10,000 for their organs. The case resulted in the confiscation of assets and restrictions on further medical procedures and the right to practice.
Beyond national legislation, researchers and government bodies agree that medical teams must obtain uncoerced, informed consent before proceeding with any organ or tissue donation.
Similarly, Nigerian law permits post-mortem organ transplants, provided two or more independent physicians, who have no connection to the transplant team, certify the death.
In addition, the physicians who establish death must state, in a dated and signed report, the method used to establish death. An individual also has the legal right to object to organ donation before death, which overrules the decision of the relatives.
Despite the standing laws against organ trafficking in Nigeria, the poor socio-economic status of the populace persists. That is, the deafening gap between the poor and the rich changes the dynamic of the humanitarian gesture for the haves and have-nots.
As a result, access to organs may be influenced not only by medical need but also by financial capacity and social status.
Those with greater financial resources may be better positioned to access transplantation within a shorter period, while poorer patients may face longer waits or fewer opportunities to receive the organs they need.
We know the data and the policy, but the gaps are still alarming. How do we increase awareness and make an actionable policy?
The journey to reduce the alienation of the two words ‘organ donation’ in Africa can be accomplished through the smallest unit in the communities, cities, and countries: the family.
Myths and misconceptions: the role of emotions and cultural and religious misconceptions result from poor orientation and a lack of detailed information about what is and what is not. Hence, there is a need for reorientation: the pros, the cons, and why it needs to be done.
Early education, for adolescents, and its incorporation into the curriculum, goes a long way in shaping values before the weight and rigour of adulthood.
Most importantly, it is who we aim to reorient. This is as important as updating policy. There is a need to consider the different strata of influence in a family. Resources such as educational information tailored to young adults can pioneer change for collective approval, and it makes the topic worthy of discussion.
That being said, there is a need to rethink what worked before. Family, the smallest unit of communities, is where considerable change can be effected.
A change in one could positively impact the response of others; if not, towards donating their organs, it could lead to honouring the request of their loved ones.
Infiltrate Active Group: When it comes to increasing awareness, influence is crucial to drive home the point. Partnering with a group grounded in the right culture and with massive active followers goes the extra mile to ensure the message is passed across.
Timely grassroots outreach to vulnerable communities, those that are prone to fall prey to the deceptiveness of trading organs for monetary gain.
Reaching people through active and recognised bodies not only helps to reduce the errors clouding these humanitarian gestures.
Most importantly, it helps represent this group’s questions and concerns when formulating policies and strategies to increase awareness.
Social Media: A social media post and strategies on paper and Google search will do little and have done little to close this gap in Africa. A change in how we tell the story could change the perspective on organ donation.
Instead of merely stating the positive outcomes of donating organs and tissues, the story (through videos, pictures with write-ups, and the journey) of this outcome from donation can paint a thousand more pictures than merely stating the words or data.
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How Does Awareness About Organ Donation Impact Organizational Policy Reform?
Aside from promoting grassroots awareness, lawmakers must revisit standing laws and policies to help address the growing billion-dollar organ trafficking in Africa.
While creating awareness seems like a non-legal approach, it can significantly influence how medical professionals procure, document, and scrutinise organs and tissues.
To achieve this, comprehensive legislation should incorporate stronger mechanisms for transparency, accountability, and equitable access, including the following:
Such a system would provide a clear framework for determining who receives an organ and would allow the process to be monitored from donor identification and assessment through to transplantation.
Consequently, recipients should be prioritised according to established medical criteria rather than wealth, influence, or social status.
Although such a system may not eliminate the financial barriers faced by poorer patients, it would create safeguards against preferential access by wealthy or influential individuals.
Established Undisclosed Detailed Waiting List
A detailed waiting list that includes recipient details, including the date and severity of the medical urgency, provides actionable steps and oversees the process, from how and who it is obtained from to interviews with the donor.
Such a system would provide a clear framework for determining who receives an organ and would allow the process to be monitored from donor identification and assessment through to transplantation.
While this might not eliminate the financial barriers faced by financially constrained patients, it would be a big feat for the poor; it is a system that safeguards against preferential access by wealthy or influential individuals.
Trace paperwork and documentation.
Despite the existing law that, for the organ donation process to be valid and free of legal action, a formal writing from the minister is required, provided the donor is not a relative of the recipient.
Fake documentation has been used to bypass this ruling; hence, due scrutiny must be in place to ensure the authenticity of the documents, and this applies to other included paperwork.
Make Organ Donation Part of Public Policy and Everyday Conversation
In Africa, organ donation is a subject that surfaces when kidneys are needed, mostly circulated on social media and in newspapers.
In many cases, appeals for organs appear on social media or in newspapers only after a patient has reached a critical stage. By then, families are often responding to an emergency rather than making an informed decision about donation.
The government could provide individuals with opportunities to formally indicate their donation preferences at major administrative milestones, such as driver’s licenses, voter cards, international passports, NHIS rights, and university admissions. This way, organ donation becomes a familiar public concept and an established component of healthcare and civic responsibility.
Provide Legal Protection and Support for Organ Donors
Post-treatment bills are often covered by donors. In a context of economic bankruptcy, this has heightened the rate of disapproval of organ donation.
For this reason, legislation should establish clear donor protections that cover medically necessary post-donation care and reasonable recovery-related expenses. Such protection should continue until the donor has sufficiently recovered to resume normal activities, subject to medical assessment.
Moreover, these protections should be recognized as enforceable donor rights rather than voluntary benefits. Where an authorized institution or responsible body fails to provide legally mandated support, appropriate mechanisms for complaint, enforcement, and legal redress should be available.
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Conclusion
Closing the persistent gap in organ donation and its consequential impact on thousands of deaths annually is achievable. However, doing so requires collaborative effort among legal authorities, the government, the media, and the education system to enforce inclusive, practical, and informative policies.
Infiltrating these sectors with proper educational insights and data from vulnerable groups in Africa plays a significant role in restructuring and providing infrastructure that increases awareness and ensures the availability of appropriate and adequate medical facilities.
While the grief of relatives prevents consent to organ donation, knowing the stance of their loved ones, in some cases, encourages approval.
Passing into law the disclosure of consent on registration or renewal of NHIS, driver’s license, voter card, etc.
By making these preferences known in advance, organ donation becomes a considered decision rather than an unexpected request presented to families during a moment of grief or medical crisis.
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