Kidney transplant programmes across Africa are achieving encouraging patient and graft survival rates despite severe financial, infrastructural and health-system challenges, according to a scholarly work published in International Urology and Nephrology.
The research, titled Kidney transplantation in Africa: a systematic review of treatment outcomes and strategies for enhancing care and sustainability, noted that kidney transplantation remains the most effective treatment for patients with end-stage renal disease (ESRD).
Still, access remains severely limited across much of the continent. One-year patient survival exceeded 90 percent in several countries, including Nigeria, Tanzania, South Africa, Ethiopia and Egypt.
This research, led by Dr Chidera Stanley Anthony and Dr Victor Oluwatomiwa Ajekiigbe, warned that these gains remain vulnerable due to high treatment costs, inadequate transplant infrastructure, limited access to immunosuppressive medicines, and weak long-term follow-up.
One-year patient survival was 90.7 percent in Nigeria, 91.2 percent in Tanzania, 90.4 percent in South Africa, 92.3 percent in Ethiopia and 98.4 percent in Egypt. Living-donor procedures dominate transplantation in Africa, largely because deceased-donor systems remain underdeveloped. One-year graft survival among living-donor recipients was 87 percent in Nigeria and 96.7 percent in Tanzania.
The researchers said expanding deceased-donor programmes could increase access while reducing dependence on family members but stressed the need for strong ethical protections for living donors.
Affordability remains one of the greatest threats to kidney care. Patients with end-stage renal disease often face the costs of repeated dialysis, medicines, investigations and hospital care. The investigation cited evidence that as many as 98 percent of patients in one setting discontinued dialysis within 12 weeks because they could no longer afford treatment.
But the shortage of kidneys raises a question beyond money and medicine: if someone agrees to sell a kidney because they desperately need the money, is that truly informed consent-or can poverty turn consent into exploitation?
The study noted that demand for kidney replacement therapy far exceeds supply in Africa, creating incentives for illegal markets such as organ harvesting. Commercial donation involving financial compensation has also raised ethical concerns.
The question is therefore not simply whether a person agreed to the transaction, but whether the circumstances surrounding that decision allow for genuinely informed and voluntary consent. Weak regulatory frameworks and limited educational resources further complicate informed consent and donor protection.
Culture and religion add another dimension. The study noted that some religious denominations do not support receiving organs, while others regard donation as a virtuous act. Attitudes towards brain death may also affect deceased-donor transplantation.
Dr Chidera Stanley Anthony, and Dr Victor Oluwatomiwa Ajekiigbe also acknowledged another Nigerian study where very few respondents had previous knowledge of brainstem death, while more than half wanted a brain-dead relative to remain on a ventilator and would not donate the relative’s organs.
The study also identified a striking gender pattern. Women were reported to donate kidneys more often than men, despite end-stage renal disease being more prevalent among men. This has been linked to emotional factors, including closeness to the recipient.
Yet women were also found to receive fewer living-donor kidney transplants than men, while men may be more likely to be excluded from donation because of conditions such as hypertension and ischaemic heart disease.
These findings raise broader questions about consent, culture, gender and fairness in a system already struggling with organ shortages.
Long-term success also depends on access to lifelong immunosuppressive medicines and follow-up. Acute rejection rates ranged from 8 to 43.4 per cent, while delayed graft function and HLA mismatches were associated with poorer outcomes. Loss to follow-up could leave recipients vulnerable to complications and interruptions in treatment.
The study also found that appropriately selected people living with HIV can benefit from transplantation, with HIV-positive-to-HIV-positive programmes recording 84 per cent survival at both one and three years.
The researchers called for stronger national transplant programmes, better financing, improved infrastructure, wider access to immunosuppressive therapy, reliable medicine supplies, transplant registries and stronger long-term follow-up systems.
For Africa, the message is both promising and urgent: transplant centres can achieve strong outcomes despite limited resources, but sustaining those gains will require health systems that make transplantation affordable, accessible and capable of supporting patients throughout their lives.