Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective study

Background. Heart transplantation in South Africa faces numerous challenges related to organ scarcity and unequal access to advanced heart therapy. There is an urgent need to analyse the current transplant referral pathway to optimise equitable access to transplantation. Objectives. To provid...

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Main Authors: R Kanyongo, G Calligaro, B Cupido, J Scherman, A Brooks, C Ofoegbu, N Da Silva, A Ryan, M Mofamadi, K Seele, P Human, J Brink, P Zilla, T Pennel
Format: Article
Language:English
Published: South African Medical Association 2024-04-01
Series:South African Medical Journal
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Online Access:https://samajournals.co.za/index.php/samj/article/view/1371
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author R Kanyongo
G Calligaro
B Cupido
J Scherman
A Brooks
C Ofoegbu
N Da Silva
A Ryan
M Mofamadi
K Seele
P Human
J Brink
P Zilla
T Pennel
author_facet R Kanyongo
G Calligaro
B Cupido
J Scherman
A Brooks
C Ofoegbu
N Da Silva
A Ryan
M Mofamadi
K Seele
P Human
J Brink
P Zilla
T Pennel
author_sort R Kanyongo
collection DOAJ
description Background. Heart transplantation in South Africa faces numerous challenges related to organ scarcity and unequal access to advanced heart therapy. There is an urgent need to analyse the current transplant referral pathway to optimise equitable access to transplantation. Objectives. To provide an audit of heart transplant referrals to Groote Schuur Hospital, Cape Town, over a 23-year period, focusing on patient demographics, indications for referral, waiting-list dynamics, and transplant referral outcomes. Methods. The study utilised a retrospective patient folder review for the period 1 January 1997 - 31 December 2019 and audited the trends in heart transplant referrals and associated outcomes of the referral at a tertiary academic hospital. Results. A total of 625 recipients were referred for heart transplantation, with the majority being male (n=412; 65.9%), while gender was undocumented for 69 cases (11.0%). The mean age was 38.1 (14.6) years, and 153 (24.5%) were listed for transplant, while 215 (34.4%) were deemed ineligible for listing. Contraindications for listing included social (n=106; 49.3%), medical (n=83; 38.6%) and psychological (n=26; 12.0%) factors, while 134 patients (21.4%) were considered too well. Poor social circumstances (n=38; 39.6%), poor insight (n=28; 29.2%) and poor compliance (n=21; 21.9%) were the most common non-medical reasons for not listing recipients, while obesity (n=30; 31.3%) and smoking (n=23; 24.0%) were notable medical contraindications. Forty-nine patients (7.8%) died during work-up, while 130 (85.0%) of the listed patients received a heart transplant. Of the 429 donor referrals, 139 (32.4%) were accepted for organ procurement. Reasons for declining donors included unsuitability for transplantation (30.3%), lack of capacity (1.8%), and recipient-donor mismatch (66.9%). Conclusion. Three-quarters of the referred patients were deemed unsuitable for heart transplantation for medical and/or social reasons. The ratio of referral to listing has decreased over time. However, once listed, the likelihood of receiving a transplant was high.
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spelling doaj-art-10ddbc09a561491a857c2210632d9c242025-02-10T12:26:11ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-04-011143b10.7196/SAMJ.2024.v114i3b.1371Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective studyR Kanyongo0G Calligaro1B Cupido2J Scherman3A Brooks4C Ofoegbu5N Da Silva6A Ryan7M Mofamadi8K Seele9P Human10J Brink11P Zilla12T Pennel13https://orcid.org/0000-0003-0218-3798Chris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaDivision of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South AfricaDivision of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa Background. Heart transplantation in South Africa faces numerous challenges related to organ scarcity and unequal access to advanced heart therapy. There is an urgent need to analyse the current transplant referral pathway to optimise equitable access to transplantation. Objectives. To provide an audit of heart transplant referrals to Groote Schuur Hospital, Cape Town, over a 23-year period, focusing on patient demographics, indications for referral, waiting-list dynamics, and transplant referral outcomes. Methods. The study utilised a retrospective patient folder review for the period 1 January 1997 - 31 December 2019 and audited the trends in heart transplant referrals and associated outcomes of the referral at a tertiary academic hospital. Results. A total of 625 recipients were referred for heart transplantation, with the majority being male (n=412; 65.9%), while gender was undocumented for 69 cases (11.0%). The mean age was 38.1 (14.6) years, and 153 (24.5%) were listed for transplant, while 215 (34.4%) were deemed ineligible for listing. Contraindications for listing included social (n=106; 49.3%), medical (n=83; 38.6%) and psychological (n=26; 12.0%) factors, while 134 patients (21.4%) were considered too well. Poor social circumstances (n=38; 39.6%), poor insight (n=28; 29.2%) and poor compliance (n=21; 21.9%) were the most common non-medical reasons for not listing recipients, while obesity (n=30; 31.3%) and smoking (n=23; 24.0%) were notable medical contraindications. Forty-nine patients (7.8%) died during work-up, while 130 (85.0%) of the listed patients received a heart transplant. Of the 429 donor referrals, 139 (32.4%) were accepted for organ procurement. Reasons for declining donors included unsuitability for transplantation (30.3%), lack of capacity (1.8%), and recipient-donor mismatch (66.9%). Conclusion. Three-quarters of the referred patients were deemed unsuitable for heart transplantation for medical and/or social reasons. The ratio of referral to listing has decreased over time. However, once listed, the likelihood of receiving a transplant was high. https://samajournals.co.za/index.php/samj/article/view/1371heart failureheart transplant
spellingShingle R Kanyongo
G Calligaro
B Cupido
J Scherman
A Brooks
C Ofoegbu
N Da Silva
A Ryan
M Mofamadi
K Seele
P Human
J Brink
P Zilla
T Pennel
Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective study
South African Medical Journal
heart failure
heart transplant
title Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective study
title_full Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective study
title_fullStr Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective study
title_full_unstemmed Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective study
title_short Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective study
title_sort two decades of recipient and donor referrals for heart transplantation to groote schuur hospital cape town south africa a retrospective study
topic heart failure
heart transplant
url https://samajournals.co.za/index.php/samj/article/view/1371
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