*1.5.1 Southern Africa*

**South Africa:** the first organ transplantation in Africa was kidney transplant performed by Thomas Starlz and colleagues in 1966 at Wills Donald Gordon Medical Centre, Johannesburg, South Africa [33]. This was followed in 1967 by the first successful heart transplant performed in the world at Groote Shuur Hospital, Cape Town, South Africa by Christian Barnard [34, 35]. Barnard and his team championed the orthotopic and heterotopic ('piggy-back') heart transplant. From 1968 to 1983, they engaged in research on cardiac transplantation thereby laying the foundation for heart transplantation as therapy for end-stage cardiac disease. The team advanced the concept of brain death, organ and tissue donation, and ethical issues in transplantation. They also researched on methods to improve preservation

and protection of the donor heart: their studies ranged from developing appropriate hypothermic perfusion for heart storage, haemodynamics and metabolic changes in brain death to xenotransplantation [34].

Though, South Africa has the most advanced transplant programme in the continent, globally, their transplant activities remain lower than those of other countries with comparable economic capacity [35, 36]. South African liver programme has existed for about 2 decades and presently offers living-related liver transplantation. Other solid organ programmes available are combined kidney-pancreas and lung transplantation. Her donor programmes have advanced to extended criteria donors (ECD) and donors after circulatory death [37]. South Africa has high prevalence of HIV resulting in a huge HIV-positive population prompting Muller and colleagues to pioneer HIV-positive-to-positive transplant program in 2008 [38]. By 2018, this programme had successfully transplanted 43 kidneys from 25 deceased donors [39].

**Namibia** had first kidney transplantation in March 2016 [40] and is also reported to have done a heart transplant [41].
