The Absence of National Dialysis and Transplantation Guidelines in South Africa: An Urgent Call for Policy Action

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The Absence of National Dialysis and Transplantation Guidelines in South Africa: An Urgent Call for Policy Action

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Co-author 1

Siyanda A Ngema ngemasa@tut.ac.za Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa *

Co-author 2

Mpho Mpiti Lisampiti@yahoo.com Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

Co-author 3

Siyabonga D Buthelezi buthelezisd@tut.ac.za Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

Co-author 4

Boitumelo Mudumela Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

Co-author 5

Lwazi S Zwane zwanelsifiso@gmail.com Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

Co-author 6

Thabiso L Bale` balethabiso@gmail.com Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

Co-author 7

Tendani S ramukumbats@tut.ac.za Tshwane University of Technology Adelaide Tambo School of Nursing Science City of Tshwane South Africa -

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

South Africa has operated without national guidelines for dialysis and transplantation for nearly half a decade, creating a critical gap in kidney healthcare policy. This absence leaves patients diagnosed with chronic kidney diseases (CKD), kidney failure (KF), previously known as end-stage renal disease (ESRD), facing uncertain access to life-saving treatments such as dialysis and kidney transplant. There is a lack of standardised criteria governing acceptance onto dialysis programs or eligibility for transplantation in the country.

Methods

This policy analysis examines the current state of renal care governance in South Africa, reviewing the implications of absent national guidelines on patient selection, resource allocation, and healthcare equity. We assessed the impact on clinical decision-making processes across provinces and healthcare facilities, comparing South Africa's approach to international best practices in nephrology and transplantation policy.

Results

The lack of national guidelines has resulted in significant inconsistencies in patient care across the country, South Africa. Selection criteria for dialysis and transplantation vary substantially between institutions and provinces, creating health-related disparities and inequitable access to renal replacement therapies. Healthcare practitioners operate without unified frameworks, leading to decision-making processes that lack transparency and standardisation countywide. This policy vacuum has produced fragmented outcome monitoring, inefficient resource allocation, and a system where access to renal replacement therapy may depend more on individual judgment, geographical location, and institutional practices than on evidence-based guidelines and equitable criteria.

Conclusion

The prolonged absence of national dialysis and transplantation guidelines represents a serious threat to healthcare equity and patient outcomes in South Africa. International evidence demonstrates that clear, standardised protocols are essential for optimal care delivery and equitable resource distribution. We urgently call on the Department of Health of South Africa, NGOs, associations, societies, and organisations to prioritise the immediate development and implementation of comprehensive evidence-based national guidelines. These must establish transparent, evidence-based criteria for dialysis acceptance and transplant eligibility, ensure consistent application across all settings, and address equity considerations. Immediate policy action is essential to guarantee fair, transparent access to life-saving kidney care.

Kewords