Transplantation

Transplantation of human cells, tissues and organs

Transplantation of human cells, tissues or organs saves many lives and restores essential functions where no alternatives of comparable effectiveness exist.

In 50 years, transplantation has become a successful worldwide practice. However, there are large differences between countries in access to suitable transplantation and in the level of safety, quality, efficacy of donation and transplantation of human cells, tissues and organs. The ethical aspects of transplantation are at the forefront. In particular, the unmet patients’ needs and the shortage of transplants lead to the temptation of trafficking in human body components for transplantation.

Human transplantation

Human cells and tissues for transplantation can save lives or restore essential functions. For example

• a corneal graft can restore sight in corneal blindness;
• the transplantation of haematopoietic stem cells can cure congenital or acquired diseases including some leukaemias
  See further information on Haematopoeitic Stem Cells
• the transplantation of a human heart valve often constitutes the best replacement situation and recipient patients do not require long term anti-coagulation therapy.

Xenotransplantation

Xenotransplantation, animal to human, defined as living cells, tissues or organs of animal origin and human body fluids, cells, tissues or organs that have ex vivo with these living, xenogeneic materials, has the potential to constitute an alternative to material of human origin and bridge the shortfall in human material for transplantation.

Donations from deceased persons should be developed to their maximum therapeutic potential avoiding, whenever possible, the inherent risks to live donors, as stated in WHO Guiding Principle 3. There is a recognized need for communities, and health professionals, to become better educated about donation and transplantation and that is the key to the success of deceased donation programmes.

However, despite the frequent use of materials donated from deceased donors, the donations from living donors are necessary for some types of transplants or to compensate for the limited supply of material available from deceased donors in order to meet patient needs. Living donation is thus practised despite the fact that it involves risks for the donor that may not be negligible.

As the procurement of human material for transplantation from deceased or living donors and the subsequent allogeneic transplantation may entail ethical and safety risks for both the recipient and the donor, strict controls and effective oversight should be carried out by the health authorities to protect them. The Guiding Principles mandate optimal care for donors and recipients.

The transparent oversight of the health authorities over donation and transplantation activities is also essential to increase the trust of the public in the system. In addition, the decision to be a donor is often based on the understanding that a contribution to the availability of transplant resources may someday benefit the health needs of the donor’s family.

WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation

In 1987 the fortieth World Health Assembly, concerned at the trade for profit in human organs, initiated the preparation of the first WHO Guiding Principles on Transplantation, endorsed by the Assembly in 1991 in resolution WHA44.25. These Guiding Principles have greatly influenced professional codes and practices as well as legislation around the world during almost two decades. After a consultation process that took several years, the Sixty-third World Health Assembly adopted resolution WHA63.22 on 21 May 2010, endorsing the updated WHO Guiding Principles and identifying areas of progress to optimize donation and transplantation practices.

The Declaration of Istanbul

Professionals of donation and transplantation from all regions, through many of their organizations and institutions, are endorsing the Declaration of Istanbul on organ trafficking and transplant tourism developed under the leadership of the Transplantation Society and the International Society of Nephrology in May 2008.