The consultation saw an
assemblage comprising of 140 government officials, ethicists, and
representatives of international scientific and medical bodies from 68
countries across the globe.
The focal point of the meet was that the participants urged the WHO, and
the professionals in the field, to consider organ donation and transplantation
as the responsibility of each nation.
The participants also asserted that it was important to meet the health needs
of a population in a comprehensive manner and
address the core issues leading to
transplantation, ranging from prevention to treatment.
Organs brain- dead
persons and persons who died as a consequence of
circulatory criteria were considered to be the best source of harvested organs.
Every country must work towards
meeting patient need within the capacity of its own growth and seek regional or
international co-operation whenever required.
strategy of working towards self-sufficiency includes the following features:
1) Begin locally
2) Include public
health measures to decrease disease burden and to increase the organ
availability for transplantation in a population
3) Enhance cooperation
among the individuals concerned
4) Be carried out
based on the WHO Guiding Principles and the Declaration of Istanbul.
must be placed on:
donation from the deceased
Support for living
Meeting the needs of
the local population in preference to 'transplant tourists'.
This need for a
comprehensive strategic policy and practice framework must be created to face
the challenges of an increasing incidence of chronic diseases.
National capacity management
Salient features include -
Development of an adequate and appropriate healthcare infrastructure and
workforce in accordance to the country's development and economic capability
Adequate and appropriate financing of organ donation and transplantation
Investment in chronic disease prevention and vaccination
National regulatory control
Appropriate legislation dealing with declaration of death, organ procurement,
consent fair and transparent allocation, establishment of transplant
organizations, penalties for organ trafficking and commercialization
Regulations to deal with procedures for organ procurement, reimbursement, and
Monitoring and evaluation systems
that lead to end-stage organ failure, through prevention and treatment, will
certainly benefit populations.
There also exists a
strong economic imperative in improving transplantation rates.Reasons-
transplantation is less costlier than dialysis,
transplantation definitely results in better survival rates and improved
productivity and quality of life
transplantation is cost effective and an important feature of comprehensive
Before and during the
meeting in Madrid, eight Working Groups identified specific goals and
challenges faced by both developing and developed countries and also analyzed
issues unique to particular societies and regions.
The Working Groups
provided an elaborate set of recommendations directed at governments,
international organizations, and healthcare professionals regarding how to
maximize organ donations from deceased persons and how to effectively meet
Recommendations from the Madrid Consultations:
Right to health and
dignity includes the recognition of human needs for organ transplantation. The
tenets of organ donation and transplantation programs are matters that come under the government's responsibility as pointed
out in Resolution WHA57.18.
Organ donation and
transplantation must play a role in every country's national health policies
intervention is required to eliminate the risk factors that lead to end-stage
organ failure. The health systems must be developed to meet the challenges of
chronic diseases such as diabetes, cardiovascular disease (CVD) and hepatitis.
transplantation legislation consistent with the WHO Guiding Principles must be
a basic necessity.
Public support for
organ donation is a necessity. This requires educating the public with an
emphasis on ethical values such as solidarity and reciprocity.
It must be remembered
that self- sufficiency
is based on three main ethical premises:
The human right to health
includes transplantation and disease prevention.
Organs should be
understood as a social resource;
should be perceived as a civic responsibility
Transplantation Reflect Comprehensive Health Care
The functions of oversight,
maintenance of professional standards and ethics, regulation, policy setting,
and monitoring and evaluation of organ donation and transplantation programs
may be effectively managed by a National Transplant Organization (NTO).
Data registries are
necessary for operational support and for monitoring practices and outcomes.
The key to
self-sufficiency is maximizing donation from deceased persons.
maximum donation of organs and optimizing the results of transplantation must
nurses involved in critical care must play a pivotal role in identifying
possible donors and facilitating donation after their death. They must be
educated in this regard.
15 June 2011 - Volume 91 - Issue - pp S29-S31