ISN-TTS Webinar: Global Access to Transplantation

Transplantation is the best and frequently the unique treatment for patients with organ failure that primarily results from non-communicable diseases, which burden is increasing in nearly all countries throughout the world. According to data from the Global Observatory on Organ Donation and Transplantation (GODT), close to 154,000 organ transplants were performed in 2019. Yet the World Health Organization (WHO) estimates that this constitutes only 10% of the organs needed for patients diagnosed with end-stage organ failure. The disparity between supply and demand of organs has likely been exacerbated during 2020 due to the COVID-19 pandemic, with an estimated decline of 15% in global transplant activities. Countries have also unequally developed organ transplantation, not only quantitatively, but also in terms of reliance upon living versus deceased donors.

The WHO has called countries to pursue self-sufficiency in transplantation by decreasing the burden of diseases treatable with transplantation and by increasing the availability of organs, with priority given to maximizing deceased donation and ensuring the protection of living donors. Depending on the level of human development, health priorities in transplantation may range from protecting the resident population from exploitation to developing deceased donation to its maximum therapeutic potential. The fundamental pillar of deceased donation is the organization of a multidisciplinary process of high complexity to ensure the systematic identification of individuals who die or about to die in conditions consistent with organ donation and their transition to actual donors. The engagement of the critical care community, the creation of a donor coordination network, efforts in professional training and continuous evaluation of performance are key elements of a successful deceased donor program. The progressive decline in the incidence of brain death, the changing profile of potential donors and the emergence of new end-of-life care practices make mandatory the search for novel strategies to further increase organ availability from the deceased: i) the transplantation of organs from expanded criteria and non-standard risk donors; ii) the routine consideration of intensive care to facilitate organ donation; iii) the promotion of donation after the circulatory determination of death. In situ and ex-situ preservation measures will help to improve post-transplant outcomes in these new challenging scenarios. With such a comprehensive approach, not only patients will gain better access to transplantation, but many other dying patients will be given the opportunity to donate their organs if this is consistent with their principles and values.