The organ transplant waiting list is a complex and carefully managed system designed to match donated organs with recipients in the most ethical, effective, and medically appropriate way possible. 

Factors such as blood type, tissue compatibility, medical urgency, time on the waiting list, and geographic location all play a role in determining who receives an organ. 

Despite the best efforts of transplant coordinators and medical professionals, the demand for organs far exceeds the supply, leading to long waiting times and difficult decisions. 

This imbalance highlights the critical need for more donors and greater public awareness.

How the Deceased Organ Waiting Lists Work

Organ transplants in South Africa are coordinated through specialised transplant centres. Allocation depends on organ type, medical urgency, compatibility, and location. Each organ has unique matching requirements and time sensitivities.

Lung Transplant
Centres: Performed in Cape Town and Johannesburg.

• Matching factors: Donor and recipient must be similar in size and blood type.
• Urgency:
  • Patients who cannot be ventilated for long or are on high oxygen support are listed as Priority 1 (P1).
  • These patients require immediate transplantation as lung failure progresses rapidly.
• Outcome: Without transplant, most P1 candidates die from respiratory failure within days to weeks.

Heart Transplants
Centres: Conducted in Cape Town and Johannesburg.

• Matching factors: Size, blood group, and tissue compatibility.
• Urgency:
  • P1 patients are those on mechanical heart support or life-sustaining medication (inotropes).
  • They are prioritised because their condition can deteriorate suddenly.
• Outcome: Without transplant, death usually occurs from end-stage heart failure or cardiac arrest.

Liver transplants
Centres:
Paediatric: Red Cross War Memorial Children’s Hospital (Cape Town).
Adult: Cape Town and Johannesburg transplant units.

• Matching factors: Size (child vs adult), blood type, and urgency.
• Urgency:
  • P1 patients include those with acute liver failure or rapidly deteriorating liver disease.
  • Paediatric cases receive priority because of limited donor availability and small size requirements.
• Outcome: Without timely transplantation, liver failure causes multi-organ failure and death.

Kidney Transplants
Centres: Conducted at both public and private hospitals nationwide, with the majority in Cape Town and Johannesburg.

• Allocation system:
  • Kidneys are matched on blood group, HLA tissue type, and waiting time.
  • The kidneys stays in the donor’s province, shared  between public and private sectors.
• Waiting time: Patients can wait 5–10 years or longer, especially in the public sector.
• Outcome: Patients usually survive on dialysis while waiting but face higher risks of infection and heart disease.

Cross-cutting rules for all organs
Priority system:

P1 (Priority 1) = patients at immediate risk of dying without a transplant.

Age consideration:
Children are prioritised for suitable organs because they deteriorate faster and have fewer donor matches.

Waiting time points:
The longer a person waits, the more points they gain, improving their chance when a match becomes available.

Extended-criteria donors:
Organs from older or medically complex donors are sometimes used when suitable — carefully matched to appropriate recipients.

Current Challenges

• Severe organ shortage:
  • South Africa has very low donor rates compared to global averages.
• Geographic inequality:
  • Most transplants occur in major cities; rural patients face limited access.
• Public vs private gap:
  • Private sector patients often receive transplants sooner due to resource availability.
• Waiting list burden:
  • Thousands of South Africans remain on waiting lists every year — many die before receiving an organ.

Why it Matters

A single donor can save up to 7 lives and restore health to several others through tissue donation. Raising awareness and encouraging family discussions can help close the gap between organ need and availability.