Kidney transplantation in Africa - workforce, capabilities, and perceived barriers

Access to kidney transplantation (KT) in Africa is reported to be limited. Lack of registry data and reliance on single-centre reports limits an accurate overview of KT on the continent. We therefore undertook a survey of all African Association of Nephrology (AFRAN) affiliated nephrologists to describe KT practices and challenges on the continent.

Voluntary participants (n = 317) were recruited from AFRAN social media platforms using snowball sampling. Participants completed an anonymised survey detailing KT practices and barriers using a Likert scale. Training and practice in KT and perceived barriers were described for the survey as a whole and sub-analysed by KT programme capability and country.

Most respondents (66.9%) were active in KT to some degree; 73.2% reported having received KT training. KT-active respondents were heterogeneously distributed, with the majority practicing in North Africa, Nigeria, and South Africa. 71.3% of respondents, representing 28 nations, reported access to a KT programme, with 18 nations reporting at least 1 local centre performing engraftment; deceased donor (DD) engraftment was available in only 6 nations. State-funded KT was available in 12 nations with the remainder relying on mixed or patient-funded models. Formalized KT regulation was reported by 26 nations. Cost of KT, lack of government support and policy, and sociocultural factors were commonly identified as barriers to KT.

Resource limitations continue to restrict access to KT in Africa. Government support is required to facilitate funding and policy development to overcome these challenges.