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South African surgeon breaks transplant ban

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7000.280 (Published 29 July 1995) Cite this as: BMJ 1995;311:280

A row has broken out in South Africa among doctors, government representatives, and the public over the place of heart transplant operations in the new health system that the government plans to set up. Dr Fanus Serfontein, a Pretoria heart surgeon, decided last week to break a provincial moratorium on all transplant operations—agreed to by hospitals, medical schools, and planners while adequate costing figures were sought.

Dr Serfontein, who has performed several heart transplant operations at Pretoria's H F Verwoerd Hospital, telephoned the Gauteng province's superintendent-general, Dr Ralph Mgijima, late at night stating that he had a 22 year old patient in need of a heart and lung transplant and that he had the organs available and the patient on an operating table. Faced with the possibility of terminating a young life with his decision, Dr Mgijima agreed.

The moratorium had been placed on transplantation in the province as the country's March budget had placed severe constraints on Gauteng and Western Cape health spending. These two provinces house most of South Africa's large academic hospital complexes, at least four of which regularly perform transplant surgery.

The budget cuts, which were severe, were the result of the new government's attempt to transfer some of the finite health resources into underserved and more rural areas. The policy, resulting in deficits in the two provinces of at least 600m rand (pounds sterling 103m) for this financial year, has been severely criticised and has also led to the attempt to rationalise transplant operations in the Western Cape.

Cape Town's famous transplant unit at Groote Schuur is likely to retain the function, while Tygerberg Hospital, which also performs transplant operations, will be told to stop.

Serfontein's move, however, has set the cat among the pigeons. A lot of media coverage made it look as if all transplants would cease in the province. Mgijima, whose hand was forced by a ferocious (and largely white) backlash, tried to put fears to rest that those needing transplants were not about to be denied them.

Christian Barnard, the heart transplant surgeon, was reported to have asked on a radio show whether Serfontein was now meant to spend his time cutting toenails. The minister of health, Dr Nkosazana Dlamini-Zuma, said late last week that there would be no end to transplant operations; she believed, however, that they should be carried out at Groote Schuur.

The issue is unlikely to fade away as opposing images of sick black babies in need of primary health care and patients waiting for transplant are displayed in the media conveying the problem which the country's health care administration faces.—PAT SIDLEY, freelance journalist, Cape Town

Would it save money to have nurses doing doctor's jobs?

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