Transplantation Numbers Are Not Good At Every Level

Picture credit:'Heart of Cape Town
Picture credit:’Heart of Cape Town

There is almost zero access to heart surgery for poor people in rural areas, who typically die without treatment, according to the self-assessment of the heart transplant unit at Groote Schuur Hospital and the University of Cape Town.

The unit, which shot to fame when the first human heart transplant was performed there 49 years ago, has lost its edge to the private sector over the past 20 years, as government’s healthcare focus changed to primary treatment of illness due mainly to the costs of transplant procedures and post-operative medication.

Assessing the 10 years from 2004 to 2014, the Chris Barnard Division of Cardiothoracic Surgery found it had suffered more drastic cuts in State funding than other specialist units as government shifted tertiary healthcare resources to primary treatment to avoid benefitting only a “few patients at significant cost”.

But, changing the focus of our healthcare resources to primary health cannot mean that people who depend on the public health sector and who need other treatments must simply disappear – or die.

South Africa’s extreme socio-economic stratification impacts access to transplant surgery. Without access to medical aid, most South Africans cannot afford the high costs of a heart transplant in a private hospital. A heart transplant in the private sector may conservatively be costed at  about R750 ooo – without the cost of ongoing medication – while the cost of a new artificial heart can go up to R2-million.

I am number 216 on the list of recipients of heart transplants in the private healthcare sector of the Western Cape, through the Christiaan Barnard Memorial Hospital.

While I will forever be thankful that private medical aid resources enabled me to be receive a donor heart at CBMH, I have become increasingly concerned about South Africans who are cut off from this life-giving treatment.

The unit was regarded as benefitting a few at great cost to the state. In particular, the unit reported a critical backlog of indigent children awaiting surgery. It also affected training of medical staff, who could not complete the required number of operations before graduating. By contrast, in the private sector, there was an oversupply of heart surgeons.

It’s difficult to get exact figures on how many heart transplants have been performed, but by piecing together various research reports, a good indication emerges. From December 1967 to November 1974, ten heart transplants were performed by the unit. According to researcher Jannie Hassoulas, in the 9-year period from 1974 to 1983, 49 heart transplants were performed. As medicine research improved survival rates, so the number of transplants increased. In the 20 years from 1983 to 2003, 489 transplants were performed.

In its 2014 registry report, the International Society for Heart and Lung Transportation noted that 116 104 heart transplants reportedly had been performed since 1967, estimating that this figure represented only about 60% of all transplants. The Society states that currently between 3500 and 5000 heart transplants are performed each year, most of those in North America and Europe. There are about 3000 potential recipients on the list at any one time.

Despite South Africa’s pre-eminence in the field, only a tiny fraction of heart transplants are performed in this country, due mainly to the costs of the procedure and the shortage of donors.

In total last year (2015), nine heart transplants were performed in the Western Cape, according to the Organ Donor Foundation. The ODF only provides regional figures, so it is not possible to say how many of those procedures were done in State or private hospitals.

Hospitals in Johannesburg performed 15 operations and those in Kwazuku-Natal 3, making up 27 hearts out of 369 solid organ transplants. Solid organs also included 71 liver and 278 kidney transplants, and 53 pancreas transplants last year. A further 179 corneas, regarded as non-solid, were also transplanted in 2015.

The report noted that in the Western Cape, there was “almost zero access” to heart surgery for poor people in rural areas. The situation can be expected to be worse in provinces like the Eastern Cape. Such people “are doomed to endure their heart disease without appropriate treatment, typically eventually dying without access to proper cardiac care”, the report notes.

The unit estimates that about 142 cardiac operations per million people were performed in South Africa in 1992. Today only about one in 10 poor patients with heart problems will receive surgery.

According to an email from the head of the unit, Prof Peter Zilla, the unit is currently exploring “brave plans… to widen the transplant base on the indigent side”. He says the unit intends using next year’s 50th anniversary of the first heart transplant to leverage additional funding and growth in donor numbers.

 

Transplantation Numbers Are Not Good At Every Level

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