The global diffusion of organ transplantation: trends, drivers and policy implications.
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.
Sydney Medical School, Charles Perkins Centre, The University of Sydney, New South Wales 2006, Australia .
Sarah L
SL
White
Department of Health Management and Policy, University of Michigan, Ann Arbor, United States of America (USA).
Richard
R
Hirth
Organización Nacional de Trasplantes, Madrid, Spain .
Beatriz
B
Mahíllo
Organización Nacional de Trasplantes, Madrid, Spain .
Beatriz
B
Domínguez-Gil
Massachusetts General Hospital, Boston, USA .
Francis L
FL
Delmonico
Service Delivery and Safety, World Health Organization, Geneva, Switzerland .
Luc
L
Noel
Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia .
Jeremy
J
Chapman
Organización Nacional de Trasplantes, Madrid, Spain .
Rafael
R
Matesanz
Organización Nacional de Trasplantes, Madrid, Spain .
Mar
M
Carmona
Organización Nacional de Trasplantes, Madrid, Spain .
Marina
M
Alvarez
Service Delivery and Safety, World Health Organization, Geneva, Switzerland .
Jose R
JR
Núñez
Department of Internal Medicine, University of Michigan, Ann Arbor, USA .
Alan
A
Leichtman
D014943:Global Health; D006291:Health Policy; D006301:Health Services Needs and Demand; D064410:Human Trafficking; D006801:Humans; D007390:International Agencies; D016377:Organ Transplantation / Q000639:trends*; D061214:Patient Safety; D014019:Tissue Donors / Q000600:supply & distribution*; D014944:World Health Organization