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Organ donation and transplantation in the European Union
Organ transplantation remains essential for the treatment of certain diseases. However, several factors must be taken into consideration where this therapeutic method is concerned: the risk of transmission of disease, the limited supply of organs and organ trafficking. This communication therefore aims to present the various potential options to ensure the quality and safety of organs, increase their availability and combat organ trafficking.
Communication from the Commission to the Council and the European Parliament of 30 May 2007 entitled “Organ donation and transplantation: Policy actions at EU level” [COM(2007) 275 final - Not published in the Official Journal].
During the past decades, organ transplantation has increased and become widespread. It is a form of treatment that is indispensable for certain diseases, and the results in terms of life years gained and improvement in quality of life are often positive.
Nonetheless, organ donation and transplantation are sensitive topics, dealt with differently throughout the EU in accordance with the cultural values and legal, administrative and organisational issues of each Member State.
Moreover, these topics present three major obstacles that the Commission intends to deal with. These are the risk of transmission of disease, the limited supply of organs and organ trafficking.
The Commission therefore plans measures to improve the quality and safety of organs, increase their availability in the EU and combat organ trafficking.
Improving quality and safety
HIV, hepatitis B and C, bacteria, fungi, parasites and various types of cancer can be transmitted when an organ is transplanted. The transmission of disease by a donor organ can result in the death of the recipient.
It is therefore essential that measures be introduced into every stage of the transplant process in order to improve the quality and safety of organs. A risk-benefit analysis must be carried out so that the organs can be allocated to suitable recipients.
This entails defining the risks to which the recipient is exposed in view of his/her characteristics and the profile of the donor, and determining the consequences of not performing transplantation. Following this analysis, a rational decision will be taken concerning the transplantation.
There is also a need for effective transportation of organs to avoid their deterioration. While maintaining medical confidentiality, the organ container must be labelled and contain the necessary documentation.
It is important to ensure traceability from the donor to the recipient. Any transplantation system must also be able to highlight unexpected complications and detect serious or unexpected adverse events.
Given that an organ donor is often also a tissue donor, the quality and safety requirements for organs will be associated with the existing community system for tissues and cells.
It is essential to set up systems for the authorisation of establishments and programmes of organ donation based on common quality and safety criteria.
However, the legislation concerning quality and safety differs from one Member State to another. A high level of protection for patients must therefore be ensured throughout the EU.
Increasing the availability of organs
The Member States are facing a serious shortage of organ donors on the one hand and an increase in the demand for organs on the other.
Rates of donors differ from one Member State to another. These differences may stem from cultural, social and historical factors in each country, and the organisational characteristics of the donation system and certain aspects of their health service.
Furthermore, families are not always made aware of the possibility of making a donation, and many potential donors are lost because they are not registered as such. The establishment of an effective system making it possible to find people who can become donors after their death thus remains essential to increase the rate of donations. This system must ensure that the organs of people who wish to become donors will really be available.
Training and employing health professionals involved in organising the donation process and identifying people who could become donors after their death has resulted in an increase in organ donations in several Member States.
Another method of increasing the number of donors is to encourage donations from living donors. These have increased in recent years, particularly because the risk to donors is low and the results of the transplants have been positive.
Donors who are not ideal because of disease and a history of malignancy (“marginal donors”) can also be taken into consideration under certain circumstances.
Raising public awareness also has a role to play in increasing donations. Society still does not take a positive view of organ donations, and some families refuse to donate the organs of deceased relatives. However, messages can influence individuals’ decisions. Effective communication therefore needs to be established. The help of communication experts is important here, and the media and health professionals need to have a better knowledge of transplantation issues.
Another way of raising public awareness is the use of a European donor card stating whether the holder wishes to donate his/her organs or not.
Fighting organ trafficking
Criminal organisations have recognised the lucrative opportunity presented by the gap between the supply of and demand for organs. As a consequence, such organisations may induce poor people to sell their organs.
Several international and Community legal instruments condemn and outlaw organ trafficking, such as the European Charter on Fundamental Rights and the Oviedo Treaty on Human Rights and Biomedicine and its Additional Protocol on the Transplantation of Organs and Tissues of Human Origin.
The Commission makes frequent reference to these instruments.
The Commission aims to make transplantation systems more efficient and more accessible. It is therefore necessary to identify the most efficient systems at EU level, promote best practice and help countries with less-developed systems to improve these.
It will also encourage the Member States to work together on establishing efficient systems aimed at identifying individuals who can become donors after their death, promoting training for professionals, encouraging donations from living donors and evaluating the use of organs from “marginal donors”.
The Commission proposes two mechanisms for action: an action plan on strengthened cooperation between Member States and a legal instrument on quality and safety of organ donation and transplantation.
The action plan will enable countries to increase organ donations and to provide fair access to transplantation, as well as exchanging expertise to improve organisational aspects.
As far as the legal instrument is concerned, a European directive setting standards of quality and safety for organs could be adopted. This instrument could, among other things, include quality and safety standards for the authorisation of establishments and programmes of organ donation, ensure a complete characterisation of the organ and establish authorisation structures.