Ethics and health

Human organ and tissue transplantation

Transplantation of human organs and tissues, which saves many lives and restores essential functions for many otherwise untreatable patients, both in developing and developed countries, has been a topic for ethical scrutiny and health care policy-making for more than thirty years. In 1991, the World Health Assembly approved a set of Guiding Principles (see link below) which emphasize voluntary donation, non-commercialization and a preference for cadavers over living donors and for genetically related over non-related donors. While they have had a great influence on professional codes and legislation, these Principles do not directly address safety concerns and they face challenges from leaders in the field who urge that policies be changed to allow the use of "incentives" to increase the numbers of organs for transplantation, from the involvement of organ donation programs in commercialized tissue operations, and from "organ trafficking" (such as that described in the 10 May 2003 Lancet) which apparently occurs in a number of countries where payment for organs is supposedly outlawed.

In response to a request from the Government of Colombia, the Ethics department (ETH), along with what is now the Department of Essential Health Technologies (EHT/HTP), undertook a study of the current issues in organ and tissue transplantation. On 28 May 2003, the WHO Executive Board, having considered the resulting report from the Secretariat, requested that the subject be reexamined and a preliminary report submitted at its next meeting in January 2004. ETH/SDE and EHT/HPT, with advice from a wide range of experts and special support from transplant officials in Spain, the United States, and France, jointly carried out a consultation process which culminated in a meeting in Madrid from 6-9 Oct. 2003, at which 37 clinicians, ethicists, social scientists, and government officials from 23 countries, representing all WHO regions and all levels of economic development, closely analysed issues of global concern regarding the ethics, access and safety of tissue and organ transplantation. The report by the Secretariat produced by EHT and ETH was accepted by the Executive Board, which on 22 January 2004 adopted a resolution recommending action by the World Health Assembly in May 2004.

On 22 May 2004, the 57th World Health Assembly adopted a slightly amended version of the resolution. The WHO Secretariat is now at work on the tasks set forth in that resolution and will report back at a later date to the Assembly.


Official WHO documents

European legislation and resources

Background documents