For a patient with blood cancer or another life-threatening blood disorder, finding a matching stem cell donor is a breakthrough. But it is not a transplant.
A patient may still be stopped by late diagnosis, fragmented referrals, delayed testing, limited specialist capacity, an unavailable transplant bed or treatment costs that neither the family nor the health system can absorb. Transport, accommodation and time away from work can also place treatment beyond reach.
South Africa therefore has to confront an uncomfortable financing reality: We are investing in finding donors without consistently financing the pathway that allows those matches to save lives.
More than 200,000 potential donors have registered through DKMS Africa over the past five years. Reaching one million by 2030 remains necessary because a larger, more representative registry improves the prospects of patients from all communities finding compatible matches.
But donor recruitment cannot be treated as an isolated measure of success. When a match is found but the patient cannot reach transplantation, the value of every rand, hour and act of public trust invested in recruitment is only partly realised.
This matters even more in a tightening health-financing environment. Africa CDC reports that development assistance for health to Africa fell from $25.8-billion in 2021 to about $13-billion in 2025. The continent carries roughly 22% of the global burden of disease but accounts for only 1% of global health expenditure.
South Africa cannot respond by waiting for external funding to recover. Nor should it try to build every expensive specialist capability independently. It needs a disciplined model that decides what must be funded locally, what can be shared regionally and where international infrastructure can close a defined gap.
The recent South African Stem Cell Society (SASMO-SASCeTS) Congress reinforced the urgency of this debate. A 2025 DKMS study, drawing on HLA data from 56,961 South African potential donors registered between 2019 and 2024, found that black African and white patients had approximately the same matching probabilities when donors and patients came from the same population group. It further modelled that a pool of one million registered black African potential donors could give black African patients an 80% probability of finding at least one fully matched donor. Although the study did not measure cost savings, its findings strengthen the investment case for growing a representative local donor pool. More local matches could reduce reliance on financially and logistically demanding international donor searches and collections, helping South Africa localise more of the transplant pathway and use scarce healthcare resources more efficiently.
Those figures should concern financial decision-makers as much as clinicians. They show that investment at the beginning of the pathway cannot deliver its full patient benefit when later stages remain unfunded or constrained.
Three reforms would help to close this gap.
1. Follow the patient and the money
South Africa needs reliable data on how many eligible patients are diagnosed, referred, tested and matched, how many reach transplantation, how long each stage takes and why patients fall out.
Without this visibility, funding will be driven by the most visible need rather than the most limiting one.
2. Establish structured co-funding before the transplant stage
Provincial health departments, medical schemes, public and private transplant centres, NGOs and philanthropic partners should agree on who funds each component of care.
Core treatment should not depend on charity but targeted support can bridge defined gaps such as HLA testing, donor-related services, travel, accommodation or an uncovered portion of treatment.
A matched patient should not have to wait while institutions decide, one by one, who will pay.
3. Use scarce specialist infrastructure more efficiently
High-throughput laboratory services, donor-search systems, research capacity and some technical expertise can be shared across borders. Domestic investment can then focus on capabilities that must remain close to patients – early diagnosis, referral networks, trained professionals, transplant beds, patient navigation and long-term care.
This is not a case for dependence. International support should be catalytic – transferring skills, strengthening existing institutions and responding to priorities identified by South African clinicians and health systems. It should not create parallel structures that disappear when a funding cycle ends.
South Africa also has the expertise to support stronger regional networks in training, diagnostics, referrals and specialist care. Regional cooperation can increase the value of scarce capacity while countries continue building their own systems.
The policy conclusion is straightforward – expanding the donor registry and financing access to transplantation must happen together.
The number of registered donors, searches and matches matters. But the measure that should guide budgets, partnerships and accountability is how many clinically eligible patients ultimately receive a transplant.
A donor match creates the possibility of saving a life. A financed pathway turns that possibility into treatment.
South Africa’s next investment decision should recognise the cost of funding the beginning of the journey while too many patients remain unable to reach the end. DM
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