This week, at the second Global Consultation on Transplantation the World Health Organization (WHO) presented countries and other stakeholders with a blueprint for updated global guiding principles on cell, tissue and organ donation and transplantation.
Those principles aim to address a number of problems: the global shortage of human materials - particularly organs - for transplantation; the growing phenomenon of 'transplant tourism' partly caused by that shortage; quality, safety and efficacy issues related to transplantation procedures; traceability and accountability of human materials crossing borders.
Stakeholders agreed to the creation of a Global Forum on Transplantation to be spearheaded by WHO, to assist and support developing countries initiating transplantation programmes and to work towards a unified global coding system for cells, tissues and organs.
A central theme of the discussions was WHO's concern over increasing cases of commercial exploitation of human materials.
"Human organs are not spare parts," said Dr Howard Zucker, WHO Assistant Director-General of Health Technology and Pharmaceuticals. "No one can put a price on an organ which is going to save someone's life."
"Non-existent or lax laws on organ donation and transplantation encourage commercialism and transplant tourism," said Dr Luc Noel, in charge of transplantation at WHO. "If all countries agree on a common approach, and stop commercial exploitation, then access will be more equitable and we will have fewer health tragedies."
Transplantation is increasingly seen as the best solution to end-stage organ failure. End-stage kidney disease, for instance, can only be repaired with a kidney transplant. Without it, the patient will die or require dialysis for years, which is an expensive procedure and often out of reach of poorer patients. Transplantation is the only option for some liver conditions, such as severe cirrhosis or liver cancer, and a number of serious heart conditions.
Recent estimates communicated to WHO by 98 countries show that the most sought after organ is the kidney. Sixty-six thousand kidneys were transplanted in 2005 representing a mere 10% of the estimated need. In the same year, 21 000 livers and 6 000 hearts were transplanted. Both kidney and liver transplants are on the rise but demand is also increasing and remains unmatched.
Reports on 'transplant tourism' show that it makes up an estimated 10% of global transplantation practices. The phenomenon has been increasing since the mid-1990's, coinciding with greater acceptance of the therapeutic benefits of transplantation and with progress in the efficacy of the medicines - immuno-suppressants - used to prevent the body's rejection of a transplanted organ.
The principles put forward by WHO underscore that the person - whether recipient of an organ or a donor - must be the main concern both as patient and as human being; that commercial exploitation of organs denies equitable access and can be harmful to both donors and recipients; that organ donation from live donors poses numerous health risks which can be avoided by promoting donation from deceased donors; and that quality, safety, efficacy and transparency are essential if society is to reap the benefits transplantation can offer as a therapy.
"Live donations are not without risk, whether the organ is paid for or not. The donor must receive proper medical follow-up but this is often lacking when he or she is seen as a means to making a profit," added Dr Luc Noel. "Donations from deceased persons eliminate the problem of donor safety and can help reduce organ trafficking."
WHO action on transplantation will be aided by a global observatory set up in Madrid under the auspices of the Government of Spain. The observatory, which is linked to the WHO Global Knowledge Base, will provide an interface for health authorities and the general public to access data on donation and transplantation practices, legal frameworks and obstacles to equitable access.