Organic change

The number of people requiring a transplant in the EU is greater than the number of organs available, says Adamos Adamou

Organ transplantation is the therapeutic use of human organs involving the substitution of a non-functional organ for another one coming from a donor. Successful organ transplants, provided that a proper follow-up procedure is applied, can restore a full and healthy life for many years to people who would otherwise often require intensive care, which is unpleasant for the patients, but also often places a burden not only on healthcare in member states but also the family and carers of the patients.

Although the use of human organs for transplantation has steadily increased during the past decades across the EU, the number of people requiring a transplant is greater than the number of organs available for transplant. Nearly 40,000 patients are now on waiting lists in western Europe. Mortality rates while waiting for a heart, liver or lung transplant usually range from 15 to 30 per cent.

Europe can increase organ donation in a number of ways, for instance by improving the quality and safety of organs. The use of organs in therapy poses a risk of diseases being transmitted to the recipient. Risks include not only the transmission of communicable diseases – viral, bacterial, and fungal infections, human, immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) – but also the transmission of malignant diseases.

The establishment of an efficient system for identifying persons that could become organ donors upon their death, once all mandatory consent requirements in member states have been met, is a key element in fighting organ shortage. For instance, in Spain each hospital has a transplant co-ordinator, who identifies potential organ donors and who can contact the family.

Organisational systems not only have an impact on the quality and safety of organs but also their availability. There are severe discrepancies in organ donation and transplantation activity within and between member states. The different organisational systems in Europe are the result of their origin and history. Comparison between countries shows that final national donation rates do not always correlate with the percentage of people who have previously declared themselves ready to donate in these countries.

This clearly indicates the importance of having an efficient transplant system in place to ensure that the organs of people willing to donate become available. A prerequisite for any action in this area is the establishment of adequate transplant systems at national level. This system needs an appropriate legal framework, which is not market-oriented, a good technical approach and organisational support. The role of competent authorities is crucial in the organisational system. These authorities must ensure compliance with basic standards and organise the donation and transplantation activities. The most efficient organisational systems should be used and promoted. 

Cooperation with international organisations (such as Europol and Interpol) must be pursued within the context of establishing a network that will facilitate the exchange of information and best practices, always abiding the strict rules of the EU on confidentiality of donor and recipient data. Public awareness and opinion also has an important role to play in increasing organ donation. Organ donation and transplantation are medical treatments that require the full participation of society for their development.

In the face of available data on the trafficking of human organs and evidence for rapidly developing commercialism and transplant tourism, it is pertinent not to underestimate organ trafficking as a secondary area of concern. It must be recognised that organ trafficking is caused by poverty and hopelessness, the desire to have work and make a living, corruption and unscrupulousness of criminals, globalisation of the economy and exploitation of human beings and that on many occasions people in the east become the spare parts inventory for the sick in the west. The best way to fight organ trafficking is by increasing organ availability.

Moreover in order to combat the practice of organ selling for money – especially in countries of the developing world – mechanisms of traceability should be put in place so as to prevent these organs entering the EU. The commission and Europol, should moreover, monitor the cases of organ trafficking.