Madrid Resolution on Organ Donation and Transplantation

The Third Global Consultation on Organ Donation and Transplantation organized by the WHO and supported by the European Commission was held in Madrid on March 23 to 25, 2010.

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.

Self-Sufficiency

Every country must work towards meeting patient need within the capacity of its own growth and seek regional or international co-operation whenever required.

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The strategy of working towards self-sufficiency includes the following features:

Actions must:

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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.

Particular emphasis must be placed on:

• Voluntary donation

• Curtailing commercialization

• Maximization of donation from the deceased

• Support for living kidney donation

• 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 program

• Investment in chronic disease prevention and vaccination

National regulatory control

Salient features include-

• 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 allocation

• Monitoring and evaluation systems

Why Organ Donation?

Addressing diseases 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-

• Kidney transplantation is less costlier than dialysis,

• Kidney transplantation definitely results in better survival rates and improved productivity and quality of life

• Kidney transplantation is cost effective and an important feature of comprehensive health services.

Common Challenges

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 patient needs.

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

• Sustained 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.

• National 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;

• Organ donation should be perceived as a civic responsibility

• Donation and 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.

• Facilitating the maximum donation of organs and optimizing the results of transplantation must be promoted.

• Physicians and 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.

Reference:

1. Transplantation:

15 June 2011 - Volume 91 - Issue - pp S29-S31

Source-Medindia