Transplants and the 77th World Health Assembly

June 27, 2024

Author: Juan Manuel Palomares Cantero

Introduction

The recent 77th World Health Assembly, held in Geneva (May 2024), has resulted in a pioneering resolution with the potential to change lives in Mexico and around the world. Driven by Spain, this resolution seeks to improve the availability, ethical access, and oversight of the transplantation of human cells, tissues, and organs. This advancement is not only relevant for its direct impact on health but also for the ethical and legal implications it addresses.

Since 2010, the number of transplants has increased significantly. In 2022, more than 150,000 solid organ transplants were performed, representing only 10% of global demand. This imbalance translates into an urgent need for more robust and equitable systems, especially in resource-limited countries like Mexico. The resolution not only aims to increase the availability of organs but also to prevent illicit practices such as transplant tourism and organ trafficking. These crimes not only affect the most vulnerable but also erode trust in health systems.

In Mexico, the implementation of this resolution will require a series of concrete measures. It is essential to integrate donation and transplant activities into health care systems, ensuring that donation is a viable option at the end of life. Additionally, living donors must be protected, ensuring they are not exploited and receive proper follow-up.

The World Health Organization (WHO) has committed to developing a global strategy on donations and transplants to be presented in 2026. This strategy will be key to establishing a World Donor Day, fostering public awareness and understanding of the need for altruistic donation. For Mexico, this agreement represents a unique opportunity. With a health system in the process of modernization and growing social awareness about the importance of organ donation, we can aspire to a future where all Mexicans have access to life-saving treatments. However, this path will not be without challenges.

It is important to strengthen the legislative frameworks and necessary infrastructure for organ transplantation. International cooperation and technical support from WHO will be essential to achieve these objectives. Mexico must take proactive measures to align its health policies with this resolution, always prioritizing the well-being and dignity of its citizens.

Besides the transplants needed to save lives, it is essential that public health policies in Mexico also consider those transplants that, although not vital, represent significant solutions for patients. A clear example is facial transplantation, which currently can only be performed thanks to private initiatives since there is no public resource for it. Integrating these procedures into public policies would ensure a more comprehensive and equitable approach to health.

At the heart of this resolution is a deep commitment to bioethics, a field that reminds us of the importance of respecting physical life and human dignity. Bioethics invites us to promote fundamental ethical principles such as solidarity, subsidiarity, justice, and the common good. Solidarity calls us to recognize and respond to the needs of our fellow citizens, especially the most vulnerable. In the context of transplants, this means working together to ensure that everyone has access to the necessary treatments to save lives, regardless of their economic or geographical situation. Subsidiarity reminds us that decisions should be made at the closest level possible to the affected individuals, respecting their autonomy and decision-making capacity. In transplants, this means respecting and supporting the decisions of donors and their families, providing the necessary information and support to make informed and uncoerced decisions. Justice demands that we distribute health resources equitably, ensuring that everyone has access to the benefits of transplantation. This implies not only increasing the availability of organs but also ensuring that health systems can provide transplants fairly and equitably. Finally, the common good urges us to consider the well-being of the entire community in our decisions and policies. In the field of transplants, this means creating systems that not only save lives but also strengthen public trust and promote a culture of donation and mutual support.

History has taught us that major advances in public health are not achieved overnight but through concerted and sustained efforts. The recent resolution of the World Health Assembly is a reminder that, when countries unite with a common purpose, significant changes can be achieved. For Mexico, the challenge lies in transforming this global commitment into concrete local actions that benefit all its inhabitants. The "Santander Declaration," emerging from the Global Transplant Summit organized by the National Transplant Organization (ONT) in November 2023, under the Spanish Presidency of the European Union, has been fundamental in the adoption of this resolution. This declaration, supported by WHO and various international organizations, emphasizes the importance of protecting living donors and promoting post-mortem donation. It also insists on the need for innovation and regulation of therapies derived from substances of human origin, thus ensuring the accessibility and sustainability of health systems. The resolution of the 77th World Health Assembly is a significant step towards a fairer and more accessible transplant system. Now, the task is for all countries, including Mexico, to implement these guidelines and ensure that all citizens have the opportunity to receive life-saving treatments.

Juan Manuel Palomares Cantero is a lawyer, master's, and doctor in Bioethics from Universidad Anáhuac, Mexico. He was Director of Human Capital, Director, and General Coordinator at the Faculty of Bioethics. He currently serves as a researcher in the Academic Directorate of Integral Formation at the same university. He is a member of the Mexican National Academy of Bioethics and the Latin American and Caribbean Federation of Bioethics Institutions. This article was assisted in its writing by the use of ChatGPT, an artificial intelligence tool developed by OpenAI.

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