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Prof Moosa appointed to chair MAC on Organ Transplantation
Author: FMHS Marketing & Communications / FGGW Bemarking & Kommunikasie – Tyrone August
Published: 03/09/2020

​South Africa has been a pioneer in organ transplants for more than half a century. In 1966, it performed the first kidney transplant on the continent and, just a year later, it carried out the first heart transplant in the world.

Yet, despite these ground-breaking achievements, South Africa still struggles today to find enough organ donors. For Prof Rafique Moosa, the newly appointed chairperson of the Ministerial Advisory Committee (MAC) on Organ Transplantation, it is a priority to address this shortage.

"The number of transplants has remained relatively static for the past 10 years or so," notes Moosa, who is the Executive Head of the Department of Medicine at Stellenbosch University and Tygerberg Academic Hospital.

For example, the number of kidney transplants in South Africa vary between just 400 and 450 a year. "We have been trying to understand why the number of donors has not increased," says Moosa, who has served on the MAC as a member since 2014.

In part, he attributes this to apathy among the general public, even though there is a high awareness of the importance of organ donations: "Unfortunately, as South Africans, we're not very generous with our organs."

Surprisingly, however, this reluctance extends to the health fraternity as well: "One of the biggest problems is the apathy among doctors and healthcare professionals. They should be referring more potential donors to us. If one looks at the total number of motor vehicle accidents [251 deaths per million population], there should be more than enough donors to supply the needs of the country."

Moosa and the other nine members of the MAC – who were appointed in January by the Minister of Health, Dr Zweli Mkhize, for a five-year term – are keen to address the shortage of organ donations. "At the end of the day," he stresses, “every single donor makes a big difference."

The MAC deliberates over every single transplant in South Africa. "All transplants in the country have to go through this committee," explains Moosa. "The only transplants that we don't review are those of living related transplants.

"We advise the Minister on foreign nationals as well, whether those are appropriate. Even if they [the donor and recipient] are related, we still have to review those."

The MAC includes representation from across South Africa to avoid any conflict of interest. Each application for a transplant – which is received via the Department of Health – is reviewed by at least two members (and, in addition, by the chairperson). "The Committee is generally very understanding and supportive, but we need to make sure there is no subterfuge," he says.

More generally, the MAC advises the Minister of Health on various aspects of organ transplantation, and provides him with policy guidelines and proposals as well on the future direction of transplants in South Africa.

The members of the current MAC are relatively new as many of the previous members have retired. Yet Moosa is confident that the present team is up to the many challenges it faces, and refers to it as "a strong committee". It now includes expertise in areas not previously accommodated on the MAC. For instance, a paediatrician and a liver expert now serve on the Committee, too.

Moosa himself is eminently suited to be at the helm of the MAC. He qualified as a medical doctor at the University of Cape Town in 1979, and joined Stellenbosch University's Department of Medicine and Tygerberg's Renal Unit when he became a nephrologist in 1989.

In 1992, he became Head of the Renal Unit, and soon after became involved in various professional organisations. In 1993, he became vice-chairman of the Organ Donor Foundation, a position he held for two years.

In 1995, he became chairperson of the Cape Kidney Association, a member of the National Kidney Foundation and president of the Southern African Transplant Society. Two years later, he became president of the South African Renal Society.

Further afield, Moosa became involved in the International Society of Nephrology in 1995, and served in many of its structures over the years. In 2008, he became a board member of Kidney Disease Improving Global Outcomes, an international non-profit organisation.

Along the way, he completed a PhD at Stellenbosch University in 2002 on malignancies in kidney transplantation. And, at the end of 2006, he was appointed to his present position, where he continues to remain active in the Renal Unit as a nephrologist.

"Most of the transplants we do in South Africa are kidney transplants, so most of the members on the MAC are nephrologists," he points out. The most active centre in kidney transplants is Cape Town, followed by Johannesburg much further back in second place.

"Cape Town is way ahead of everybody else," says Moosa. "Unfortunately, because of the Covid-19 pandemic, there is a decision not to do any transplants unless it's an emergency. So, essentially, we've stopped doing kidney transplants, and only doing urgent liver transplants at the moment."

Further down the line, the MAC hopes to persuade the Department of Health to increase expenditure on organ transplantation and on dialysis. “One of the major difficulties we face is that there are grossly insufficient opportunities for patients to be dialysed," says Moosa.

"Only a fraction of patients with kidney failure are actually accepted for renal replacement therapy transplantation and dialysis. In the Western Cape, only about a quarter of patients with kidney failure get dialysis. The rest are treated conservatively – in other words, they pass away.

"So we've been trying to encourage the Department of Health to open up more facilities and to allow more patients to be treated with dialysis. We want to become advocates for patients with chronic kidney disease and promote more dialysis." There are currently only 30 dialysis units in the public health sector.

Yet Moosa remains hopeful that the MAC will continue to make steady progress in reaching its various objectives. "It's a fairly challenging job, and often involves life and death decisions," he says. "But we work as a team; we share responsibility."