Ethics and health

Human organ and tissue transplantation

Report by the Secretariat


1. At the request of the Government of Colombia, this item has been included in the provisional agenda of the Board. This note outlines current issues.

2. Transplantation of human organs and tissues1 saves many lives and restores essential functions in circumstances when no medical alternative of comparable effectiveness exists. The transplantation of solid organs, such as kidney, liver, heart or lung, is increasingly a regular component of health care in all countries, and is no longer a feature of health care in high-income countries alone. Of the 70 000 or so solid organs transplanted annually, 50 000 are kidney replacements, more than one-third of the latter operations are done in low- or medium-income countries. The number of human tissue transplants is increasing in both developed and developing countries, but global data on this form of transplantation are less complete. In Europe, hundreds of thousands of tissue transplants are performed each year, and in 1999 an estimated 750 000 people in the United States of America received human tissue, twice as many as in 1990. Globally, it is estimated that 120 000 corneal transplantations and 18 000 transplantations of allogeneic haematopoietic progenitor cells took place in the year 2000.

3. Transplantation has been recognized to be cost-effective in many settings. For example, in developing and developed countries alike, kidney transplantation not only yields survival rates and quality-of-life that are far superior to those obtained with other treatments for end-stage renal disease, such as haemodialysis, but is also less costly in the long run. Skin allografts or amnion grafts are effective burn-wound dressings and are within the reach of low- or medium-income countries. Similarly, corneal transplantation can successfully relieve corneal blindness in many cases.

4. Nonetheless, the transplantation of organs and tissues does raise ethical concerns. In 1991, through resolution WHA44.25, the Health Assembly endorsed a set of Guiding Principles on Human Organ Transplantation.2 These Guiding Principles - whose emphases include voluntary donation, noncommercialization, genetic relation of recipients to donors and a preference for cadavers over living donors as sources - have considerably influenced professional codes, national, state and provincial legislation, and the policies of intergovernmental organizations. Yet they do not directly address safety concerns. Further concerns arise because practices that depart from the Guiding Principles, such as reliance on living organ donors and payments for organs, have increased in some places over the past dozen years.

1 This includes human cells for transplantation such as haematopoietic stem cells from bone marrow, peripheral blood or cord blood. The use of gametes, embryonic and fetal tissue as well as blood and blood products raises additional questions that need to be separately addressed.
2 Document WHA44/1991/REC/1, Annex 6.