1. SYSTEMS
GOVERNANCE
AND SERVICE DELIVERY
WHO Guiding Principles
on Human Cell, Tissue and OrganTransplantation
and the Quest for Self-Sufficiency."
Luc Noel MD
Coordinator “Clinical Procedures “ HSS/HDS/CPR
World Health Organization Geneva

2. Partnerships, Collaborations
2004 and Global Consultations Process
Network
Health authorities
• National Transplantation Agencies
• National Regulatory Authority
• Policy makers
Scientific and Professional Societies
Official relation with The Transplantation Society
Experts Ethicists, lawyers
Patients- Donors and Recipents
Civil society
Every Region of the Globe and level of
development
Towards a Common Global Attitude to Transplantation
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

3. 2010 WHO Guiding Principles on
Human Cell, Tissue and Organ Transplantation
GP 5 Free donation and no purchase of human transplant as such,
but cost & expenditures recovery
GP 6 GP 7 GP 8
GP 3 Promoting Responsibility Justifiable fees
Maximizing DD No advertising for transplant origin
Protecting LD
GP 2 GP 4 GP 9
Death Δγ Protecting the Equitable allocation
No conflict incompetent
GP 1
Consent DD
Donor Process Recipient
GP 10 Monitoring long term outcomes. Quality and safety of procedures and products
GP 11 Transparency, openness to scrutiny, anonymity
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

4. The Pursuit of Self-sufficiency
in Donation and Transplantation
Equitably meeting the transplantation needs of a given
population using resources from within that population.
Country, sub-region, region, globe
• Self-Sufficiency implies both self-reliance and sufficiency in supply
• The goal of Self-Sufficiency is global as is the human right to health
and dignity
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

5. Organ Donation and Transplantation:
Striving to Achieve Self-Sufficiency
Third WHO Global Consultation on Organ Donation and Transplantation, Madrid March 2010
The Madrid Resolution
A new paradigm centered on national accountability
1. Preventing the need for transplantation and
increasing organ availability are national
responsibilities
2. Donation and transplantation reflect
comprehensive health care
3. Opportunities to donate should be provided in as
many circumstances of death as possible
Transplantation June 15, 2011 - Volume 91 - Supplement 11S FREE at
http://journals.lww.com/transplantjournal/toc/2011/06151
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

6. Self Sufficiency. A New Paradigm
Defragmentation to Decrease and Meet Needs
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

7. The Road Towards Self-Sufficiency
Third WHO Global Consultation on Organ Donation and Transplantation,
Madrid March 2010 - Report Transplantation Supplement June 15 2011
National Health Authorities
Policy
Regulation
Organization
Developing
Education for Deceased 4D
Donation from
4D Education for
Donation Donors Prevention
School Curriculum
Self-Sufficiency
Access for all to safe, efficient and ethical transplantation
Societal Progress
Societal Progress
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

8. The 4Ds Programme
Developing Donation from Deceased Donors
1. Critical pathway for organ donation from
deceased persons
2. Blue print for a national system for organ
donation from deceased persons
3. Collaborations with G/NG O for
regional, sub-regional and country
implementation
4. Global consensus on criteria for the
determination of death
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

9. Management of Diseases Leading to Transplantation
Multidisciplinary and Collaborative
Third WHO Global Consultation on Organ Donation and Transplantation, Madrid March 2010
Comprehensive management of diseases leading to end stage organ
failure from prevention to treatment
− Integration of prevention in health care
− Transplant specialists must be promoters of prevention
− Evidence based strategies and documentation
Integrated management of end stage renal failure with the objective to
increase access to transplantation
− Collaboration between policy makers professionals and health
payers
− Consolidation of RRT’s
− Transparency and indicators for efficiency
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

10. Levels of Transplantation Capability
Third WHO Global Consultation on Organ Donation and Transplantation, Madrid March 2010
1. Legal and regulatory frameworks and implementation
2. Resources and professional development for transplant
services
3. Resources and professional development for donation
and coordination
4. Government resourcing
5. Community involvement
6. Assessing and minimizing need for organs
In the development of transplantation services, these
components should be initiated from the very beginning on
Health Systems Health System Governance Clinical
and Services and Service Delivery Procedures

11. Thank you
noell@who.int
Health Systems Essential
and Services Health Technologies