WATCH | Why organ donor numbers are so low in SA
South Africa faces a continuing shortage of donated organs for patients seeking life-saving transplants.
A lack of education, late referrals and families declining consent have been recognised as major barriers to organ donation.
Stella de Kock, MD of Transplant Education for Living Legacies, a patient-founded South African non-profit organisation focused on organ and tissue donation, education and awareness, said the lack of knowledge around the issue was a major challenge.
August is National Organ and Tissue Donor Awareness Month in SA, and about 5,000 people are on waiting lists for organ transplants.
De Kock, who has lived with end-stage kidney failure since 2011 and relies on dialysis, said only a small proportion of dying people were suitable for organ donation.
“Only one percent are suitable, because a lot of people die of heart attacks and things like that at home. By the time they get to the hospital, their heart has already stopped,” she said.
WATCH | Stella de Kock, managing director of Transplant Education for Living Legacies (TELL), has lived with end-stage kidney failure since 2011 and relies on dialysis. She is using her own journey to raise awareness about organ and tissue donation and encourage South Africans to… pic.twitter.com/H4yITckv9r— Sowetan (@Sowetan1981) August 19, 2026
The heart generally needs to still be beating for organs to remain suitable for transplants.
For organ donation, a person generally needed to be declared brain dead in hospital, said De Kock, adding that people often misunderstood what took place from that moment onwards.
“When you’re brain dead, you’re dead. All that they’re [medical staff] doing is they’re making sure the organs are viable for transplant,” she said.
But even when someone is a potential donor, the process can be scuppered if healthcare professionals do not identify the individual, and do not then refer them to a transplant co-ordinator.
De Kock said families were another major barrier, particularly if they had never discussed donation. “If the family never had the conversation, and they never talked about organ and tissue donation, what do you think they’re going to do? They’re just going to say ‘no’,” she said.
Families were often still in shock and grieving when approached for an organ donation from the deceased. “They don’t have the capacity to even deal with a discussion about organ donation.”
De Kock said people also knew less about tissue donation than organ donation, which is done after death. Tissue includes corneas, skin, bone and tendons. Corneas can restore sight, while donated skin can help treat severe burns.
“If you die at home in your sleep, you can only be a tissue donor,” De Kock explained.
Tissue can be retrieved after death, subject to medical assessment and time limits.
De Kock said donation did not prevent a normal funeral. “You can have an open casket. No one’s going to know that you were an organ or tissue donor. You don’t look different.”
Living donation is another option. A living donor may donate a kidney or part of their liver, but must undergo strict medical assessments. “For a living donor, unlike a deceased donor, you need to be in perfect health.”
Living donors did not necessarily have to be related to recipients. “You also don’t have to know anyone who needs a liver or a kidney.”
Some people believe religion or culture prevented organ donation. De Kock said many of these beliefs were based on misconceptions. “Most religions do support organ donation because you’re helping someone else. I think it’s just the lack of knowledge.”
“You just have the conversation with your family because that is the most important part,” she said. “If they know what your wishes are, then they can honour them.”
For De Kock, organ donation is ultimately about leaving a legacy beyond death. Her message is simple: learn about donation, challenge myths and talk to your family about your wishes.
One conversation could help another person’s story continue and give another person a chance at life.