A review of policies and programmes for human organ and tissue donations and transplantations, WHO African Region.

André Loua,Stanislav Kniazkov,Aissatou Sougou,Margot Feroleto,Jean Baptiste Nikiema,Ossy Muganga Julius Kasilo,Prosper Tumusiime,Walter Fuller

doi:10.2471/blt.19.236992

Abstract

Several resolutions, endorsed by the World Health Assembly and the United Nations General Assembly, articulate the need to improve the availability, quality and safety of organ and tissue donation and transplantation, as well as to prevent and combat trafficking in human organs. Here we assessed the implementation of these resolutions pertaining to organ and tissue donations and transplantations by sending out a questionnaire to all 47 countries in the World Health Organization African Region. From 33 countries that provided data, we identified several obstacles and challenges. Compared to other regions, there are very limited data on organ donation and transplantation. Most countries are lacking legal and regulatory frameworks, since they did not yet establish a specific or comprehensive legislation covering donation and transplantation of human organs and tissues. Countries also have a poor national capacity to perform organ and tissue transplantations and the organization and management of national programmes are weak. Funding, both from domestic and external sources, is insufficient to implement effective transplantations programmes and patients have inadequate financial protection. To address these challenges, we propose that countries and partners should develop and implement policies, strategies, plans and regulatory frameworks for all aspects of organ and tissue donations and transplantations, including fighting against organ trafficking and transplant tourism. Where donation and transplantation programmes exist, stakeholders should develop the skills of human resources, adopt technical standards and quality management procedures to improve donation and transplantation of human organs and tissues.

Highlights

Most countries in the World Health Organization (WHO) African Region are experiencing a rapid increase in noncommunicable diseases.[1,2,3,4] This increase could have a devastating effect on a region with significant resource constraints, because of the costly and resource demanding health-care provision needed to treat many of these diseases
The assessment showed that financial resources for organ and tissue donations and transplantations came from public sources in six countries (Algeria, Comoros, Ethiopia, Ghana, Mali and Seychelles) while recipients were responsible for paying for posttransplant care and drugs in 14 countries (Burkina Faso, Côte d'Ivoire, Ethiopia, Gabon, Ghana, Guinea, Kenya, Madagascar, Mali, Namibia, Nigeria, Rwanda, Uganda and Zimbabwe) including for procedures done outside these countries
The present assessment provided an overview of the current situation of organ and tissue donations and transplantations in the African Region and can serve as the baseline for WHO support to countries

Summary

Introduction

Most countries in the World Health Organization (WHO) African Region are experiencing a rapid increase in noncommunicable diseases.[1,2,3,4] This increase could have a devastating effect on a region with significant resource constraints, because of the costly and resource demanding health-care provision needed to treat many of these diseases. We identified several challenges in organ and tissue donations and transplantations that countries in the African Region are facing Examples of these challenges are: (i) insufficient legal requirements and weak regulatory frameworks; (ii) lack of access to transplantation centres due to the absence of appropriate infrastructure; (iii) insufficient technical expertise, including competent human resources and technology; (iv) unavailability for immunosuppressive agents; and (v) lack of funding for such programmes.[8,18,20,21] Table 1 summarizes the situation of organ and tissue donations and transplantations in the assessed countries. In the few countries having transplant centres, the national programmes donation and transplantation of organs and tissues were not consolidated These programmes had generally inadequate infrastructures, insufficient institutional support, lack of technical expertise, including competent human resources and technology.

Algeria

15 Single kidney transplants from related living donors

Findings

Conclusion