The Global Alliance for Transplantation

Click here to view the Consensus Statement of the Amsterdam Forum (PDF Format, opens in new window)


1. Introduction

Organ transplantation is a successful therapy for end stage organ failure of the kidney, liver, heart, lung, pancreas and intestine. Transplantation of cells and tissues has also transformed the therapeutic options for patients with malignant haematological disease, eye disease and orthopaedic disease, and has the potential to alter significantly the therapeutic options for patients with diabetes and a range of disorders.

The access of patients to transplantation therapy varies widely across the globe, partly determined by the underlying level of economic development in different states and partly determined by other factors such as the availability of organ, cell and tissue donors, or the specialist provision of health services.

The Transplantation Society has determined that it will seek to address global inequities in transplantation therapy, in order to facilitate appropriate access to transplantation for all patients who would benefit.

Table – Transplantation of organs in different continents/regions year 2000

  Kidney
(pmp*)
Liver
(pmp)
Heart
(pmp)
USA 52 19 8
Europe 27 10 4
Asia 3 0,3 0,03
Latin America 13 1,6 0,5
*Per million population

2. Goals and major strategic directions

The Goal of the Global Alliance in Transplantation is:

To provide access to transplantation for all patients in need

The initial Strategic programs will be directed at:

  1. Statistics - To foster the global collection and analysis of data on donation and transplantation of all organs and cells.
  2. Education – To develop and share expertise in transplantation globally.
  3. Professional Standards – To develop and maintain global professional standards in the provision and management of transplantation.

3. Proposed Structure and Governance of the Alliance

The following diagram outlines the proposed relationships with other organisations and associations.

The Global Alliance for Transplantation will be an entity of The Transplantation Society and will formally report to the Council. It will thus be managed through public accounts held by The Transplantation Society and formal legal responsibilities will be assumed by The Transplantation Society. Management of the Global Alliance for Transplantation will be conducted through The Society Offices and will be funded by specific funds raised for the Global Alliance purposes.

The Board of the Global Alliance for Transplantation will be constituted by the members of the Alliance. The Board will include invited observers – such as those from the World Health Organisation and the Pharmaceutical industry. It is envisaged that the WHO will not wish to become a formal member of this board, because of the legal implications that such a membership may carry. It is envisaged that Professional and commercial organisations will become formal members on the understanding that legal and financial liabilities are strictly limited.

The Board will be responsible for the Strategic directions of the Global Alliance for Transplantation and will be responsible for providing advice on and prioritising projects designed to fulfill the strategic directions.

The Board will be responsible for the maintenance of the Global Alliance’s program and for reporting on its progress.


4. Relationships to other organisations and associations

  • World Health Organisation
  • International, Regional and National Transplantation Societies / Associations / Organisations

It is envisaged that the Global Alliance for Transplantation will permit a variety of relationships.

It is expected that the World Health Organisation will seek relationships with global organisations in fulfillment of the World Health Assembly resolution 57.XX . It is hoped that the Global Alliance for Transplantation will thus provide a vehicle for the WHO’s relationships with global professional organisations.

There are several international and regional professional organisations with transplantation as their core activity. There are international Associations – such as the International Xenotransplant Association, which are sections of The Transplantation Society but require full voice in their areas of interest. Examples of international organisations are the International Society for Heart and Lung Transplantation and the International Society of Nephrology, which may wish to be participants in relevant global discussions. Regional organisations such as the Asian Society of Transplantation and Latin-American Transplantation Society also need to have full participation in global dialogue on important transplantation issues.

The Global Alliance for Transplantation will thus have a category for organisational membership of the Global Alliance Advisory Board. This will allow independent organisations to join the Alliance, to hear and participate in the discussions and to implement strategies through the Alliance and as part of the Alliance.


5. Relationships to the Pharmaceutical industry

The Pharmaceutical Industry has both an important convergence and conflict of interest with the Global Alliance for Transplantation. Clearly it is in the interests of the industry that the overall volume of transplantation increases – a core intent of the Alliance. The structure of the Alliance is thus designed to ensure that there is the opportunity for participation in the discussion at the Alliance Advisory Board. It is also designed to ensure that the individual projects can be funded either through the Alliance or separately. This will give the Alliance the broadest options to minimise both potential conflicts of interest and competitive commercial conflicts.


6. Strategic Directions

6.1 Statistics - To foster the global collection and analysis of data on donation and transplantation of all organs and cells.

There are currently a number of initiatives directed at the collection of donation and transplantation statistics on a global scale. Perhaps the most developed are in the area of unrelated haematopoetic stem cell (HSC) transplantation where the Bone Marrow Donor Registries around the world collaborate to present data on 8.5 million potential donors of HSC’s on the internet and collect and publish data annually on all unrelated HSC transplants performed globally (www.worldmarrow.org).

In the area of solid organ donation and transplantation there is a variety of aproaches to data collection and analysis. The Council of Europe, through the endeavors of the Spanish ONT, has reported annually on the cadaver and living donation rates observed in a number of countries both within Europe and more widely from countries where the data are available. The Collaborative Transplant Study, based in Heidelberg, Germany, is probably the best example of an international data collection designed to address scientific questions in organ transplantation. There are many excellent national registries which analyse specific data sets, such as the ANZDATA registry in Australia and New Zealand and the UNOS derived Scientific Registry of transplant Recipients (SRTR) in the USA.

Despite these enormous efforts it is not possible to access an accurate source on the number, rates and outcomes of all forms of transplantation globally, the best that we can achieve is estimations. This is not a sound basis for the future and thus one of the crucial strategies for the Global Alliance in Transplantation is to foster the collection and analysis of global data.

6.2 Education – To develop and share expertise in transplantation globally.

The availability of expertise in transplantation continues to grow through the application of many efforts designed to provide education and training in both formal and informal environments. If transplantation therapy is to be more widely adopted it will be crucial to have a global capacity to train and educate specialist surgeons, physicians, pathologists, nurses, donor and transplant coordinators and allied health professionals. An important component of increasing the capacity of transplant centres will be to provide comprehensive approaches to education, rather than an occasional courses or individual attachments to transplant units. This strategy must thus address the strengths and weaknesses of available education mechanisms and develop the capacities needed to augment current processes.

6.3 Professional Standards – To develop and maintain global professional standards in the provision and management of transplantation.

There is a lack of published professional standards that are needed to provide a sound basis for progress and development of transplantation services. The first steps have been taken recently to provide a professional evaluation and determination of the standards that should be applied to the assessment, surgery and follow up of living kidney donors. There is a need to develop equivalent standards in many areas of clinical practice, based upon evidence where it is available and upon peer evaluated analysis and decision where it is not available.


7. Implementation Timetable

The implementation process commenced with a series of meetings at the Vienna Congress of The Transplantation Society in Sept 2004. Consultations allowed the ideas and views to be collected from a diverse group of individuals and organisations.

The concepts outlined in this paper will be collated with the views raised by the consultations and a formal draft business plan for The Global Alliance for Transplantation will be written and presented to potential members of the Alliance by March 25, 2005.

An interim Advisory Board of potential members of the Alliance will meet to discuss the draft business plan and then adopt a final version during 2005.

Our Corporate Sponsors

TTS gratefully acknowledges the Corporate Partners whose generous support makes the work of the Society possible:

  • astellas
  • roche
  • sanofi