Following its annual general assembly meeting in Edinburgh, which ended at the weekend, the World Medical Association, issued the following press statements:

WMA Urges Action To Combat Growth Of Tuberculosis In Prisons

Concern about the spread of tuberculosis and other communicable diseases in prisons led the World Medical Association to issue a new Declaration at its annual assembly at the weekend.

Entitled the Declaration of Edinburgh, where the meeting was being held, the Statement - published today - warns that prisons can be breeding grounds for infection and says that prison doctors have a duty to report any deficiencies in health care.

It declares: "Overcrowding, lengthy confinement within closed, poorly lit, badly heated and consequently poorly ventilated and often humid spaces are all conditions frequently associated with imprisonment and which contribute to the spread of disease and ill-health. Where these factors are combined with poor hygiene, inadequate nutrition and limited access to adequate health care, prisons can represent a major public health challenge."

The Statement adds: "An infectious prisoner poses a risk not only to other prisoners but also to prison personnel, the prisoner's relatives, other prison visitors and the wider community when the prisoner is released. The most effective and efficient way of reducing disease transmission is to improve the prison environment, targeting overcrowding for the most urgent action."

The Declaration warns that the increase in active tuberculosis in prison populations and the development of "multi-drug" resistant forms of tuberculosis is reaching very high prevalence rates in some parts of the world.

Other conditions, such as Hepatitis C and HIV disease, pose transmission risks from blood to blood spread, or sharing and exchange of body fluids. Overcrowded prison conditions also promote the spread of sexually transmitted diseases.

The Declaration calls for action to ensure that prisoners are not isolated or placed in solitary confinement without adequate access to health care, that inmates' health status is reviewed within 12 hours of transfer to a different prison and that there is follow-up treatment for prisoners on their release. It also calls for mechanisms in those rare cases where there might have to be compulsory detention of individuals who pose a serious risk of infection to the wider community.

Dr Delon Human, secretary general of the WMA, said: "The Statement says that physicians working in prisons have a duty to report to the authorities any health care deficiency provided to inmates and any situation involving high epidemiological risk for them. And national medical associations are obliged to protect those physicians against any possible reprisals".

WMA Adopts New Guidance On Organ Transplantation

New guidance on the ethics of organ and tissue donation and transplantation has been approved by the World Medical Association.

The Statement, adopted at the WMA's annual general assembly in Edinburgh at the weekend examines the tension between the desire to procure organs for medical treatment on the one hand and the preservation of choice and personal liberty on the other. It considers the professional obligation of physicians to their individual patients and their responsibilities to the patients' family and it declares that the obligation to the patient has primacy over any obligations in relationship to family members.

The Statement refers to free and informed decision making about organ donation and says that in countries where presumed consent has been adopted or is being considered, every effort should be made to ensure that the policy does not diminish informed donor choice, including the patient's right to refuse to donate.

The WMA encourages all its national medical association members to support the development of comprehensive, coordinated national strategies on organ and tissue procurement and its Statement also refers to the establishment of national donor registries, the development of protocols in hospitals, the position of prisoners in informed consent and determination of death. It says that payment for organs and tissues for donation and transplantation should be prohibited.

Finally it declares that xenotransplantation raises special issues, particularly in light of the risk of unwitting cross-species transmission of viruses and other pathogens. It says there is an urgent need for extensive public debate on this issue and it calls for the development of international guidelines to govern these practices. Transplantation of brain or reproductive tissues should not become accepted treatments until there has been extensive public debate, scientific review and publicly acceptable and scientifically sound guidelines have been developed.