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February 2004 - Organ and Tissue Transplantation
Human organ and tissue transplantation is one of the great success
stories of modern medicine. What were high-risk experimental procedures
just three or four decades ago are now routine medical therapies.
Innumerable lives are extended and improved through the replacement
of diseased body parts - kidneys, hearts, lungs and the list continues
to expand.
In one important sense, however, transplantation has been a victim
of its own success. The number of available replacement organs
is considerably less than what is needed to treat all the patients
who can benefit from this therapy. Despite major efforts by medical
associations, patient groups and governments to increase the supply
of organs and tissues for transplantation, the waiting lists for
these procedures continue to grow in many countries, and numerous
patients die before they can be treated.
The shortage of organs, especially in countries where there are
cultural or religious barriers to organ retrieval, has given rise
to international trafficking in transplantable organs, primarily
from living donors. This has been widely reported in the press
(see, for example, www.guardian.co.uk/g2/story/0,3604,1099282,00.html),
but despite condemnation from many quarters, it seems to be continuing.
In 1991 the World Health Assembly endorsed a set of Guiding Principles
on Human
Organ Transplantation that emphasized voluntary donation, non-commercialization,
genetic relation of recipients to donors and a preference for
cadavers over living donors as sources. In May 2003 the WHO Executive
Board reviewed a report
that recommended updating of the Guiding Principles, and in October
2003 WHO sponsored a conference on "Ethics, access and safety
in tissue and organ transplantation: Issues of global concern."
The conference report can be viewed at www.who.int/ethics/topics/en/madrid_report_final.pdf.
The May 2004 World Health Assembly will consider a resolution
that includes recommendations on harmonizing global practices
and collecting data on human organ and tissue transplantation
around the world.
At its 2000 Assembly the WMA adopted a revised and updated policy
on Human Organ and Tissue Donation
and Transplantation. The WMA invites the WHO, other international
organizations, national governments and non-governmental organizations
involved in policy development on this issue to take note of the
WMA policy, which was the result of long deliberation and widespread
consultation.
January 2004 - Health Databases
During the past decade the traditional medical ethical principle
of confidentiality, i.e., the physician's duty to protect the
patient's personal health information, has come into increasing
conflict with the perceived need for health information databases
serving administrative and research purposes. Computerization
has greatly facilitated the establishment and linking of such
databases. In response, governments have adopted laws to regulate
their operation. These laws have generated much controversy, with
privacy advocates complaining that they are more about facilitating
access to personal health information than protecting privacy,
and administrators, researchers and some medical associations
criticizing the bureaucratic requirements that the laws impose
on routine medical and research practices.
Genetic databases and biobanks have been of particular concern
because of the sensitive nature of personal genetic information
as well as its commercial value.
Numerous national medical associations have been very active lobbying
their governments for legislation and regulations that protect
patient information while facilitating its exchange for patient
care and legitimate administrative and research purposes.
To help their members interpret and implement the requirements
of database legislation in their jurisdictions, several national
medical associations have prepared guidance documents and related
tools. To cite just a few:
At its 2002 Assembly in Washington, DC, the WMA adopted a landmark
policy statement on health databases, the Declaration on Ethical
Considerations Regarding Health
Databases. The initial impetus for this policy was a request
from the Icelandic Medical Association to support its opposition
to certain aspects of proposed legislation on the creation of
a genetic database in that country, particularly the provisions
on consent and opting-out. Under the leadership of Dr. James Appleyard,
then Chair of the WMA Medical Ethics Committee, a workgroup developed
a draft statement and after extensive consultation and many revisions,
the document was finalized and adopted as WMA policy. The consultation
process included a joint WMA/WHO symposium on health databases
held in conjunction with the WMA Council and Committee meetings
in May 2000.
The WMA policy will be of interest to any individual or organization
responsible for personal health information.
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