The number of heart transplants being performed in South Africa has practically halved over the past decade in the face of a donor shortage.
Heart surgeon Dr Willie Koen, who heads the Christiaan Barnard Memorial Hospital's heart transplant unit, said that a decade ago 30 to 40 heart transplants were carried out every year in South Africa. Lately, only about 15 to 20 a year were being done.
Koen said the strained health system was struggling to find suitable heart donors because it did not have the staff, or the hospital beds to properly accommodate them. Meanwhile, the waiting list was growing longer.
He explained that patients from accidents, for example, could be heart donors if they were brain dead. However, the process between the accident and the transplant was a time-consuming and costly one, with which the health system could not always cope.
The patient would first have to be taken to the nearest hospital where they would have to be suitably cared for.
"But the beds at hospitals are already blocked," said Koen. "Hospitals would rather give beds to patients who have a chance of survival than those who are brain dead. There are not enough beds in ICU, even at private hospitals, to make them a priority."
A nurse would then have to care for the patient around the clock while an appropriate recipient was found, he said.
The private and public health sectors work together - mostly through an organ procurement network - for transplants, ensuring that the best match between a recipient and donor is made, no matter which hospital they are at.
Netcare's national trauma and transplant manager, Mande Toubkin, said: "The transplant programme is unfortunately struggling due to a considerable lack in the referral of suitable donors."
A Cape provincial health department spokesperson, Faiza Steyn, responded to a recent inquiry on the issue by saying that transplant activity had waned on an international scale.
Ten years ago, the average age of a donor was 25, but that had now gone up to 35.
She was speaking after transplants at Groote Schuur Hospital were suspended for several months last year while authorities probed the deaths of two patients.
She said they had found that the two transplants had failed as a result of "unrecognised disease" in the donor hearts, which had came from donors who were older than usual.
Koen agreed that the donor shortage had led to the use of "marginal" rather than "optimal" donors, where the quality of the heart was still high although from an older donor. The hearts of marginal donors, he said, were usually given to patients who stood less chance of surviving the surgery and the post-operational period.
He said the slump could be improved if there were greater awareness about organ donation, and if neurosurgeons who evaluated potential donors as being brain dead, co-operated in referring patients, with the permission of their families.
Organ Donor Foundation director Philippa Douglas said all that was needed was for people to express their wish to be an organ donor to their family.
For donor information call toll-free: 0800 22 66 11.