Kidney transplantation in Africa—workforce, capabilities and perceived barriers

BACKGROUND: 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. METHODS: Voluntary participants (n = 317) were recruited from AFRAN social media platforms using snowball sampling. Participants completed an anonymized 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. RESULTS: 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. Overall, 71.3% of respondents, representing 28 nations, reported access to a KT programme, with 18 nations reporting at least one local centre performing engraftment; deceased donor 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. CONCLUSION: Resource limitations continue to restrict access to KT in Africa. Government support is required to facilitate funding and policy development to overcome these challenges.