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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
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
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
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
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
Self Sufficiency. A New Paradigm
  Defragmentation to Decrease and Meet Needs




         Health Systems   Health System Governance     Clinical
          and Services       and Service Delivery    Procedures
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
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
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
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
Thank you

noell@who.int




  Health Systems        Essential
   and Services    Health Technologies

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Luc Noel Who - Tuesday 29 - WHO guiding principles on Human Cell, Tissue and Organ Transplantation and the quest for Self-Sufficiency

  • 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