Nouakchott Declaration: Promoting Organ Donation and Transplantation in Africa

BACKGROUND AND HYPOTHESIS: Africa faces a growing crisis of end-stage organ failure driven by the rising burden of non-communicable diseases and fragile health systems. Behind these figures are preventable deaths, disrupted families, and widening inequities in access to lifesaving care, an inequity that organ transplantation could address. However, access to transplantation remains extremely limited across the continent. According to the 2024 Global Observatory on Donation and Transplantation (GODT) report, only 544 kidney transplants were performed in Africa, representing approximately 0.5% of global transplant activity. These procedures occurred in 36 transplant centers, corresponding to roughly one center per 13.2 million inhabitants, illustrating the structural gap in transplantation services. METHODS: This work synthesizes a continent-wide expert initiative. In May 2025, the first African Forum on Organ Donation and Transplantation was held in Nouakchott, Mauritania, bringing together more than 300 experts from 12 countries. A Delphi consensus process was conducted to develop a unified framework addressing transplantation challenges in Africa. RESULTS: The Delphi process led to the adoption of the Nouakchott Declaration, a strategic framework aimed at accelerating transplantation system development, reducing preventable mortality, and promoting ethical organ donation. The Declaration outlines eight core principles addressing governance, public awareness, financing, and regional cooperation. It integrates recommendations from the World Health Organization and the Declaration of Istanbul, while adapting them to Africa-specific challenges such as workforce shortages and limited resources. CONCLUSIONS: The Nouakchott Declaration provides a structured and context-sensitive roadmap to strengthen organ donation and transplantation systems across Africa. Its implementation could reduce inequities in access to transplantation and improve survival outcomes, while promoting ethical and sustainable healthcare development on the continent.