Cautious optimism for European action plan on organ donation and transplantation

The European states differ in the degree to which they have adopted and implemented the action plan for organ donation and transplantation. Many countries have put great effort into living donation and the appointment of transplant coordinators, but there is still room for improvement where raising public and social awareness of donor issues is concerned.
 

In recent years the number of organ transplantations carried out has increased and transplantation has become a fairly routine medical procedure. For example, for kidney failure, an organ transplant is the best and most cost effective treatment available and for organ failure of the heart, liver or lungs, a transplant is often the only option for survival. Yet, in spite of this there is a shortage of donor organs throughout the whole of Europe. To address this issue, the European Union drew up an action plan – the Action Plan on Organ Donation and Transplantation (2009-2015): Strengthened Cooperation between Member States – in 2009.
 
Action points
The plan contains action points that can help Member States to tackle the shortage of donor organs. In addition, the action points are aimed at the quality and safety of the procedures surrounding organ donation and transplantation. The action plan is complementary to other regulatory requirements and as such is not binding. Three years after the approval of the action plan and at the request of the European Commission, the Netherlands Institute for Health Services Research (NIVEL) systematically documented the extent to which the plan has been implemented in the Member States, newcomer states candidate states and other European countries; this amounts to 35 countries in all.
 
Consensus
Considering the cultural diversity of the various European countries, the fact that there is a consensus for the action plan should be seen as a big step forward. In recent years, most European countries have been able to improve efficiency where organ donation is concerned. Action points such as the appointment of transplantation coordinators in hospitals, the exchange of experiences with living donation and the exchange of donor organs between countries have been adopted by nearly all countries. And in many countries improvements have been achieved through quality programmes, evaluations and successful organisational models.
 
Diversity
Some countries, including the Netherlands have a well-developed system for organ donation and transplantation although they still have a major shortage of donor organs. Other countries are only just beginning to set up such a system. In addition, the legislation in place in different countries varies, so that the role of relatives differs between them. And whilst in some countries, including the Netherlands, the number of living donors donating an organ is increasing; in other countries this does not take place at all. But diversity also carries opportunities.
 
Learning from each other
“The challenge for the European Union is to find suitable ways of dealing with this diversity,” says researcher Professor Roland Friele of NIVEL. “Differences between the European countries mean that we can learn from each other. That is something that has to be embraced. But not all countries know how to do this, in many countries there is only limited monitoring and awareness of what has been successful and so there is relatively little feedback available to allow them to learn and improve. The next step will be for the countries to systematically examine how efficient they have been and to learn from what they find.”
 
Research
The data has been collected from a literature study, a study among representatives of the 35 European states, an online focus group discussion between the states and from a study among policy-makers of the European Union. 

Funding
European Commission: DG SANCO, Executive Agency for Health and Consumers (EAHC)
 
Cooperating partner
Centre for biomedical ethics and law, KU Leuven, Belgium (Herman Nys)