Reimagining liver transplantation in South Africa: A model for justice, equity and capacity building – the Wits Donald Gordon Medical Centre experience

Abstract

The challenge of providing effective and integrated liver transplant services across South Africa's two socioeconomically disparate healthcare sectors has been faced by Wits Donald Gordon Medical Centre (WDGMC) since 2004. WDGMC is a private academic hospital in Johannesburg and serves to supplement the specialist and subspecialist medical training provided by the University of the Witwatersrand. Over the past 14 years, our liver transplant programme has evolved from a sometimes fractured service into the largest-volume liver centre in sub-Saharan Africa. The growth of our programme has been the result of a number of innovative strategies tailored to the unique nature of transplant service provision. These include an employment model for doctors, a robust training and research programme, and a collaboration with the Gauteng Department of Health (GDoH) that allows us to provide liver transplantation to state sector patients and promotes equality. We have also encountered numerous challenges, and these continue, especially in our endeavour to make access to liver transplantation equitable but also an economically viable option for our hospital. In this article, we detail the liver transplant model at WDGMC, fully outlining the successes, challenges and innovations that have arisen through considering the provision of transplant services from a different perspective. We focus particularly on the collaboration with the GDoH, which is unique and may serve as a valuable source of information for others wishing to establish similar partnerships, especially as National Health Insurance comes into effect.

Needs must: living donor liver transplantation from an HIV-positive mother to her HIV-negative child in Johannesburg, South Africa

“…Our health system has the depth and capacity to offer this highly specialised service. Compared with HIV management, access to transplantation is, unfortunately, less equitable and poorly funded—particularly in the state sector 4. Numerous factors are thought to influence solid organ availability in SA, and these seem to occur at many different levels simultaneously.…”

“…In response to an unmet need for liver transplantation, we started a paediatric liver transplant programme in 2004. To increase access to transplantation for children with liver failure, we expanded the donor pool by introducing a living donor liver transplant programme in 2013 4 6. As more children were referred to our programme for evaluation of end-stage liver disease, questions about the feasibility of transplantation from an HIV-positive living donor were frequently raised by our staff and by parents.…”

Increasing deceased organ donor numbers in Johannesburg, South Africa: 18-month results of the Wits Transplant Procurement Model

“…In 2016, deceased-donor organ procurement at Wits Transplant, based at Wits Donald Gordon Medical Centre in Johannesburg, South Africa (SA), was in a state of crisis. As it is the largest-volume solid-organ transplant unit in SA, [1] and as we aspire to provide transplant services of an international standard, the time to address our procurement practice had come. The human resources component of Wits Transplant was overhauled, with incoming management determined to address some of the shortfalls.…”

Wits Transplant Annual Data Report 2018 Adult and Paediatric Liver Transplantation

“…Despite considerable challenges, Wits Transplant has created a model of equitable care that provides access to transplantation for any adult or child with ESLD, irrespective of payer status. (1)(2)(3) As the programme continues to expand and diversify, and in the absence of a national liver transplant registry, annual reporting of outcomes was implemented, which is mandatory in many international transplant centres. As such, this is the first annual report for Wits Transplant.…”