From split livers to machine perfusion: the 20-year evolution of liver transplants in South Africa

South Africa is no stranger to organ transplants.

The world’s first heart transplant was performed in the country in the 1960s .

There have been major developments in the decades since then.

In the 1980s an organ donor registry was set up and local surgeons have been pushing the boundaries of what is possible.

The Wits Donald Gordon Medical Centre recently marked a milestone of completing 1,000 liver transplants since initiating its programme in 2004.

The Conversation Africa asked Jerome Loveland , head of transplant surgery at the centre and academic head of transplantation at the University of the Witwatersrand, about the current state – and future – of liver transplantation in the country.

How has the liver transplant landscape in South Africa changed? In the 1980s, the University of Cape Town started to build a deceased donor liver transplant programme.

It became the centre of liver transplantation in South Africa for decades.

When we at the Wits Donald Gordon Medical Centre started our own unit around 2004 , it shifted the landscape.

Obviously, it’s never smooth, and one of the most limiting factors around transplantation is the availability of deceased donor organs.

Right from the beginning we were looking for ways to optimise the use of the livers that did become available.

Very early on we embarked on more complex transplants, like reducing a whole liver into a small piece to put into a child, or dividing a whole liver into two usable pieces where one piece goes to an adult and the other to a child.

So “split liver” transplants allowed us to use those livers optimally.

From there, we expanded into living donor transplantation, typically from a parent to a child, and then transplants across the blood group barrier.