Stronger follow-up on EU organ donation action plan is necessary, health expert says

The EU Action plan on organ donation has encouraging greater co-operation on organ donation and transplants but stronger follow-up on its implementation is necessary, a Croatian health policymaker told EURACTIV in an interview. EPA-EFE/SASCHA STEINBACH

This article is part of our special report Reviving EU ambition on organ donation and transplantation.

The EU Action plan on organ donation has been encouraging greater co-operation on organ donation and transplants but stronger follow-up on its implementation is necessary, a Croatian health policymaker told EURACTIV in an interview.

“The ongoing political focus on this sensitive field of public health is essential to ensure its further sustained advancement,” said Mirela Bušić, who was appointed in 2003 as the national transplant coordinator at Croatia’s health ministry.

The EU action plan was put forward by the European Commission in 2008 as a non-binding tool to strengthen cooperation among member states on organ donation and transplantation.

It helped improve national policy and the activities of organ donations, according to a Commission impact study in 2017 which found that there had been an increase of 4,641 transplants within the EU.

According to Bušić, member states now need to further strengthen capacities and enhance governing and clinical leadership in deceased organ donation.

“A broader collaboration at the national and EU level should be strongly promoted, as it is a shared responsibility of the national competent authorities and relevant professional societies such as critical care, neurology, emergency,” she said.

Room for improvement

In particular, deceased organ donation pathway should be systematically integrated within hospitals’ end-of-life policies to ensure that an opportunity for organ donation in hospital settings is never missed.

In her view, it is crucial to ensure that the end-of-life decision-making process, when medically appropriate, respectfully addresses organ donation in the context of the patient’s best interest and preferences.

Among the recommendations made by the Commission in its 2017 assessment, the EU executive stressed the need to understand and overcome obstacles that critical care professionals face to incorporate donation in end-of-life care plans.

“For such a highly sensitive and optimized approach, critical care professionals should be trained properly and systematically,” she said.

She added that funding for the development of training programs, educational platforms, methodology and tools for more effective monitoring on quality indicators and hospital performance in deceased organ donation should be ensured at both national and common EU levels.

“Additionally, transplantation registries are essential to measure outcomes, improve quality and safety standards and ensure transparency, which in turn promotes equity and benchmark transplantation practice,” she stressed.

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Croatia’s donation culture

Croatia’s Ministry of Health carried out a 10-year stepwise approach from 2001 to 2011 to boost organ donation. It resulted in a 5-fold increase in deceased organ donation rate, from 7 to 35 per million people.

In 2015, the donor rate reached 40 per million population, putting Croatia among the countries with the highest capacity in terms of provision of deceased organ donation and transplantation services.

“The altruistic act of donation, as a highly appreciated gesture of loving care for others, has been nourished in Croatia for decades,” Bušić said.

Integration of the topic of organ donation in school curricula, along with public campaigns focusing on “real stories”, has created a positive public perception of organ donation.

Therefore, the “culture“ of altruistic deceased organ donation is widely embraced – as well as tissue, cells and blood donation, by Croatian society.

“The Croatian transplantation program is comprehensively grounded on the highest professional standards and ethical principles of altruistic donation, solidarity and equity that all successfully mirror the WHO guiding principles,” Bušić concluded.

Speaking before the European Parliament’s health committee (ENVI) in January, Croatian Health Minister Milan Kujundžić listed organ donation and transplantation among the current Croatian presidency health priorities, together with ageing and cancer care.

However, a High-Level Conference on Organ Donation and Transplantation in Zagreb has been cancelled, along with other meetings, to limit the spread of COVID-19 pandemic.

A Croatian spokesperson told EURACTIV that, given the crisis and the fact that experts were engaged in the fight against COVID-19, the presidency concluded that there was no room for a quality contribution on this topic.

“We will continue to work actively with the Commission and member states on this topic in the forthcoming period, taking into account, in particular, the presented legislation on the evaluation of blood, cells and tissues.

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