**8. Conclusion**

Sub-Saharan Africa, comprising of 47 countries and occupying an area of about 24 million Km2 is heterogeneous with estimated population of 1.1 billion people. Most of the countries belong to the LICs and LMICs according to World Bank Classification of economies. This region has a high prevalence of end-organ diseases including CKD, CLD, chronic lung diseases and chronic heart diseases resulting from CDs and NCDs.

Although South Africa performed Africa's first kidney transplant in 1966 and pioneered heart transplantation in 1967, SSA lags behind the developed world in transplant activity. According to WHO, SSA contributes the least number of transplant activity per WHO World region. Cost of treatment, low GDP, inadequate infrastructural and institutional support, dearth of facilities and technical expertise and absence of subsidy have all adversely affected organ donation and transplantation.

The health-care systems in SSA are weak and deficient. Peoples' decision to access healthcare services is influenced by knowledge of the disease condition, accessibility to health-care facility, affordability, religious and trado-cultural practices. Many people in LRCs patronize alternative healthcare service including traditional health providers and religious institutions as first choice resulting in late presentation to hospitals.

These challenges can be surmounted by adopting the 2007 World Health Organization Regional Consultation recommendations of establishment of national legal framework, self-sufficient organ donation and transplantation in each country, transparent transplantation practice, and prevention of commercialized transplantation and TT. In addition, establishment of national registries of organ transplantation is essential.
