*1.2.1 End-stage kidney disease (ESKD)*

In 2014, Stanifer *et al* [7], in a systematic review and meta-analysis of 21 studies in SSA documented an overall CKD prevalence of 13·9%. According to the Institute for Health Metrics and Evaluation (IHME) data, CKD and DM were the 14th cause of death in SSA in 1990 but worsened to 11th by 2017 (see **Figure 1**). Hypertension and DM constitute the main NCDs that cause CKD globally [8]. In many low resource countries (LRCs), chronic glomerulonephritis and interstitial nephritis assume significance because of the pervading and persisting high prevalence of CDs (mainly bacterial, parasitic, and viral infections) [9]. Human Immunodeficiency virus (HIV) infection which continues to plague SSA, albeit better controlled, is a key driver of kidney disease. Of the 38 million people living with HIV globally, more than 25 million live in this region [10, 11]. The recent pandemic of COVID-19 infection which has adverse acute effects on the kidney has probable

*Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges DOI: http://dx.doi.org/10.5772/intechopen.94986*

#### **Figure 1.**

*Causes of deaths in sub Saharan Afirca 1990 and 2017 [from Institute for Health Metrics and Evaluation (IHME) data].*

unknown long-term sequelae [12]. Both CDs and NCDs fuel the high and increasing prevalence of CKD in LRCs. Without renal registries in many LRCs, there is poor documentation of data on kidney diseases.

#### *1.2.2 Other end-organ diseases*

Viral hepatitis is prevalent in Africa with high endemicity of Hepatitis B Virus (HBV) in SSA and Hepatitis C virus (HCV) in North Africa. Africa has approximately 60–100 million of the world's 257 million viral hepatitis infections [13]. The WHO noted that between 1980 and 2010, cirrhosis-related deaths doubled in the region. The increasing burden of obesity and DM leading to non-alcoholic fatty liver disease contributes to high prevalence of CLD and end-stage liver disease (ESLD). Up to 40% of patients with chronic hepatitis may progress to liver cirrhosis and/or liver cancer [14] and without liver transplantation mortality is estimated at about 15% in one year [15]. All patients with ESLD will invariably require liver transplantation; however, liver transplants are uncommon in SSA.

There is scant information on prevalence of other end organ failures such as heart, lung, and small bowel requiring organ transplantation in SSA.

#### **1.3 Prevalence of transplantation**

The WHO in collaboration with the Organización Nacional de Trasplantes of Spain set up the Global Observatory on Donation and Transplantation (GODT) with the mandate to document the distribution of organ transplantation programmes in the countries that report their data to the Observatory and to evaluate the access of transplantation activities worldwide [16]. Upon subsequent request of the World Health Assembly (Resolutions WHA57.18 and 63.22) that global data on the practices, safety, quality, efficacy, epidemiology and ethical issues of allogeneic transplantation be collected and documented, the GODT was inaugurated in 2007 [16]. This database has ensured provision of transparent and equitable monitoring of national transplant systems.

Currently, according to the GODT database, [17], 139,024 solid organ transplants were reported globally in 2017: 90,306 kidney (36% from living donors), 32,348 liver (19.0% from living donors), 7881 heart, 6084 lung, 2243 pancreas and 162 small bowel transplants. Africa contributes the least number of transplant activity per continent and SSA the least number per WHO World region (**Tables 1** and **2**; **Figure 2**). **Tables 1** and **2** show data from 2016 GODT Report.

Kidney transplants are available in 102 countries; living kidney transplants in 98 countries and deceased donors in 76 countries [16]. Sixteen countries representing 6.6% of the global population perform only living donor kidney transplants. In SSA, a handful of countries carry out transplantation: South Africa, Sudan, Seychelles, Ivory Coast, Namibia, Nigeria, Kenya, Ghana, Tanzania, Mauritius, Ethiopia but only five countries (Ethiopia (0.34 pmp), Kenya (1.51 pmp), Nigeria (0.47 pmp), South Africa (6.81 pmp) and Sudan (6.58 pmp)) report their data to GODT (**Figure 2**).
