Abstract
Rising incomes, the spread of personal insurance, lifestyle factors adding to the burden of illness, ageing populations, globalization and skills transfer within the medical community have increased worldwide demand for organ transplantation. The Global Observatory on Donation and Transplantation, which was built in response to World Health Assembly resolution WHA57.18, has conducted ongoing documentation of global transplantation activities since 2007. In this paper, we use the Global Observatory’s data to describe the current distribution of – and trends in – transplantation activities and to evaluate the role of health systems factors and macroeconomics in the diffusion of transplantation technology. We then consider the implications of our results for health policies relating to organ donation and transplantation. Of the World Health Organization’s Member States, most now engage in organ transplantation and more than a third performed deceased donor transplantation in 2011. In general, the Member States that engage in organ transplantation have greater access to physician services and greater total health spending per capita than the Member States where organ transplantation is not performed. The provision of deceased donor transplantation was closely associated with high levels of gross national income per capita. There are several ways in which governments can support the ethical development of organ donation and transplantation programmes. Specifically, they can ensure that appropriate legislation, regulation and oversight are in place, and monitor donation and transplantation activities, practices and outcomes. Moreover, they can allocate resources towards the training of specialist physicians, surgeons and transplant coordinators, and implement a professional donor-procurement network.
Highlights
In May 2004 the World Health Assembly adopted resolution WHA57.18, in recognition of the global increase in transplantation activities, the associated risks to patient safety, the trafficking of organs for transplantation and the trafficking of human beings as sources of such organs
We used Global Observatory data to investigate the current distribution of global transplantation activities and the temporal trends in rates of solid organ transplantation for each Global Burden of Disease region.[4]
We identified the Member States driving these trends and the health policies that were associated with substantial increases in transplantation activities between 2006 – i.e. the first year for which the Global Observatory collected comprehensive data – and 2011
Summary
In May 2004 the World Health Assembly adopted resolution WHA57.18, in recognition of the global increase in transplantation activities, the associated risks to patient safety, the trafficking of organs for transplantation and the trafficking of human beings as sources of such organs. The designation of levels of health system capacity – as a framework by which to evaluate the stage of development of national organ donation and transplantation programmes – was proposed during the WHO Madrid Consultation in 2010.9 By applying the Global Observatory data to such a framework, we broadly describe where each Member State stands with. Level 5 An established multi-organ deceased donor transplant programme exists that is capable of providing kidney, liver, heart, lung and pancreas transplantation either locally or via formal international cooperative organ-sharing agreements. National counts for all living and deceased donor transplants – kidney, liver, heart, pancreas, lung and small bowel – were obtained from the Global Observatory on Donation and Transplantation database.[3] Activity data were available for 105 Member States in 2011.
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