Historical roots of organ donation disparities in South Africa from colonialism to the present

Within transplant medicine, South Africa holds a paradoxical position: as the location of the first successful human-to-human heart transplant in 1967, it is also shaped by colonialism and apartheid, which routinely denied equitable healthcare access. This review places Dr Christiaan Barnard’s historic surgery within a broader sociopolitical context and examines how historical structures continue to affect donation rates and public trust. Drawing on Foucauldian biopower, Titmuss’s gift theory and Waldby’s notion of bio-value, it argues that the transplant crisis in South Africa, with the critically low deceased donor rate, currently 1.4 per million population, is not merely a logistical or awareness problem but an outcome of biopolitics, which has a legacy of distrust regarding the body across generations. Post-apartheid reforms, including the National Health Act of 2003, did not eliminate the disparities; systemic reform, culturally sensitive research, and infrastructure investment remain necessary. A narrative historical review methodology was employed, synthesising peer-reviewed literature, archival sources, and South African legal frameworks, interpreted through Foucauldian biopower, Titmuss’s gift theory and Waldby’s notion of bio-value. This review contributes to the social science and health literature by grounding a persistent public health crisis in its historical and biopolitical foundations, and by identifying directions for future research on organ donation decision-making in South Africa.