Transplantation

Transplantation of human cells, tissues or organs is the best – and often the only – way to save lives for people with serious or life-threatening diseases and injuries.

Transplantation involves replacing non-functional cells, tissues or organs with healthy counterparts that are obtained from another individual through voluntary donation during their lifetime or after their death. 

Access to transplantation varies a lot between countries, as does the safety, quality, efficacy of donation and transplantation of human cells, tissues and organs. Growth and development of transplantation worldwide is highly unequal and faces many challenges including:

• lack of national strategies for transplantation;
• inadequate legislation, ethical frameworks and regulation, which may allow for practices such as organ trafficking;
• lack of donation, processing and transplantation infrastructure;
• deficient universal health coverage, meaning that access to transplantation is excluded; and
• low awareness and engagement amongst the public and healthcare professionals.
  

Ethical concerns are a major issue. The shortage of organs can lead to illegal activities, like trafficking in body parts for transplants.

Research into alternatives, like using animal products (xenotransplantation) or bioengineered materials, is progressing. These could help reduce the need for human donations but aren’t yet a full replacement. Even when they become available, high costs might limit access. For now, ensuring access to human cells, tissues, and organs for transplantation remains critical.

The benefits of tissue transplantation include survival after severe burn trauma, recovery of movement, closure of chronic wounds, rehabilitation of heart function and restoration of sight. Tissue transplants allow many recipients to return to economically productive lives and promote their independence.

Organ transplantation is often the best if not the only treatment for acute and chronic organ failure. Non-communicable diseases such as diabetes and arterial hypertension, combined with various social determinants such as alcoholism and obesity, may lead to chronic kidney disease and liver cirrhosis. In terms of survival, quality of life and cost-effectiveness, kidney transplantation has better outcomes than dialysis. In chronic or acute liver failure, as well as some cardio-respiratory conditions, transplantation is the only option.

Over 1.5 million patients have undergone haematopoietic stem cell transplant, primarily for haematological cancer. Its potential for treating non-malignant disorders and genetic diseases such as sickle cell anaemia and thalassemia with this type of transplant is increasingly recognized. Previously, only limited treatment options were available, and with no hope of cure.

Increasingly, treatment non-malignant disorders and genetic diseases with haematopoietic stem cell transplant is being considered.

Initiated by the Fortieth World Health Assembly, the WHO Guiding principles on human cell, tissue and organ transplantation are a significant contribution to this area of health care, providing an orderly, ethical and acceptable framework for the acquisition and transplantation of human cells, tissues and organs for therapeutic purposes. They were updated in 2020 (WHA Resolution 63.22) to reflect changes in practices and attitudes, and they continue to greatly influence the development of appropriate professional codes and practices, as well as legislation, around the world.

Following a WHO report showing a lack of progress in the development of transplantation worldwide, the World Health Assembly adopted a new resolution in 2024 (77.4) on increasing availability, ethical access and oversight of transplantation of human cells, tissues and organs. The resolution calls for:

• Member States to strengthen regulatory frameworks, integrate transplantation into health care systems, increase deceased donation rates, protect living donors from harm and exploitation, and raise public awareness. 
• WHO to support Member States through the development of a Global strategy on donation and transplantation.
  

WHO acknowledges the different needs and resources of health systems, the importance of respecting previous and current initiatives, and the commonalities among the established transplantation activities. To ensure relevance, it relies on the expertise of its advisory bodies and extended expert consultations, as well as the continued work with collaborating centres and non-State actors.