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Organ transplantation
Keywords: Human tissue, Xenotransplantation, Biomedical Research
ISRAEL (2008)
For CDB I
Developments in the field of Bioethics: ISRAEL - November 2007-May 2008
1. New Israeli Legislation in Biomedicine
Two important laws were recently adopted by the Israeli parliament (K nesset) on Brain death and on
Organ transplantation. They are available (in Hebrew) at the Bioethics Israeli website
http://www.academy.ac.il/bioet hics/index.html
Following is a non-official summary of the two Laws.
Law regarding Brain-respiratory death
The law establishes that death can be declared in case of brain death causing cessation of
autonomous respiration, as distinguished from Heart -respirat ory death (i.e. cessation of heart
pulsation). Brain-respiratory death can be declared only by two physicians who have been specifically
certified as competent for this purpose. Certification, after appropriate training, will be bestowed on
medical specialists by a committee comprised of a) four expert physicians, b) three rabbis experts in
Jewish law one of which being himself a physician, and c) one et hicist, one philosopher and one
lawyer, these 3 being appointed on the recommendation of the President of the Supreme Court, when
one these three is also a physician, and one is also a representative of a non -Jewish sector of the
Israeli public. The physicians who will declare a Brain -respiratory death must not be treating physicians
of the dying patient, and not be involved in organ trans plantation. The conditions to declare Brain -
respiratory death include a) that the cause of the brain damage be clearly known, b) a clinically proven
absolute cessation of autonomous respiration, c) a clinically proven complet e and irreversible absence
of brain function, including of the brain stem, d) the demonstration of the abs ence of brain and brain
stem activity by instrument ation including Brainstem Auditory E voked Response (B.A.E.R.),
Transcranial Doppler (TCD), Sensory Evoked Pot ential (SEP), Computerized Tomography (CT) -
Angiography (CT - A), Magnetic Resonance Imaging (MRI) and Angiography (MRA), as well as e)
elimination of any medic al situation that could cause an error on the instrumental results. After Brain -
respiratory death is declared, the treating physician will inform the family inquiring whether the patient
had expressed a specific will on the matter, so that if determination of Brain -respiratory death is against
the religion or the specific will of the patient, he will not be disconnected from articial respiratory
machines and will continue to receive sustaining treatment until Heart death.
(Law adopted March 31, 2008, going int o effect in May 2009)
Law for Organ transplantation
The law prohibits anyone from receiving remuneration for an organ taken from his own body or from
another person, whether it is taken during life or after death. Likewise, it is prohibited to give remuneration
for an organ to be transplanted in one's own body or to another person. However, the law does not
prohibit certain types of transaction or rewards: 1) that a living person consents to donate an organ to a
patient in exchange for the cons ent of a parent or friend of the second to donate an organ to a parent or
friend of the first; 2) reimbursement of expens es incurred by a live donor (according to section 22 of the
law, see below); 3) forms of reward given by an organism especially accredited by the Ministry (according
to section 29, see below); 4) payment of funeral and transpo rt of the body of a deceased from which
organs were donated after his deat h. But the law particularly prohibits any financial transactions through
intermediaries or agents making deals between donors and recipients. The law does not prohibit
transactions for transplantation in anot her country provided the laws of the other country are respected
and all measures prohibiting organ trafficking are respected.
In Israel, the law establishes a National center for organ transplantation (NCOT) at the Ministry of He alth,
that will act to maximize the potential for organ donation and manage a data bas e and waiting list for
transplantation. The NCOT is the body responsible for supervising and monitoring all activities related to
organ donation and transplantation, and will be directed by an interdisciplinary steering committee
comprising at least three physicians, a nursing specialist, a lawyer, a psychologist, a social worker, a
medical ethicist, and representatives of patient's organizations and of religious bodies. A mong the duties
of the steering committee is to make rules about how to alloc ate the legally donated organs, rules which in
addition to medical considerations will also take into account 1) the prior consent to donat e organs after
death given by a person who is now himself in need of receiving a transplant, or has a first -degree relative
in need of a trans plant; 2) the prior donation of an organ from a deceased, if a first -degree relative is in
need of a transplant; 3) the prior donation during life of an organ for the benefit of anyone, if the donor or a
first-degree relative is in need of a transplant. The steering committee will mak e its rules by majority of
votes. A physician will be appointed as comptroller of the procedures.
Procedure for organ donation from the living. A person wishing to donat e an organ to a patient in need
of a transplant, must seek authorization either 1) from a Local E valuation committee appointed by the
hospital director, if the patient in need is a relative of the donor (including brother/sister in law), or 2)
from a Central E valuation committee appointed by the Ministry of Health, if the patient in need is not a
relative of the donor (including an unidentified recipient). These E valuation committees will be headed
by a senior hospital physician not involved in organ transplantation, and include a psychiatrist or
specialist in clinical psychology, a social worker, a representative of the public sector to whom the
donor applicant belongs (if he so wishes), a judiciary -qualified lawyer. The authorization will be
delivered only if the committee is convinced that 1) the donor has no medical or mental conditions
which could cause him to incur a special risk; 2) the donor has given his free voluntary consent, in
clear mind and without any pressure being it familial, social or ec onomic pressure; 3) the donor and the
recipient have given their informed consent to the surgical procedures involved; 4) the donor did not
give his consent in return for an actual or promised compensation that is prohibited by the law and also
not for the purpose of receiving the reimbursement of expenses authorized by the law; 5) the donor
understands that he can wit hdraw his consent at anytime without prejudice. In addition to thorough
medical and psychological examination, and social evaluation, the donor and the recipient will be
directly interviewed by the evaluation committee, and the decision will be by majority of vot es and
given within 60 days. If a member of a local evaluation committee opposes the authoriz ation, he can
ask to refer the case for a new evaluation by the central committee. A positive decision to authorize the
live donation will be transmitted in all its details to the Director -General of the Ministry of Health, who
must approve it, or else reject it, within 7 days. Once approved, the proc edure should be carried out
within 24 hours. The law further addresses the right of the donor and recipient to be informed of the
results of the evaluation. The law also addresses the case of donors who are minors, where a
judgment by appropriate courts of law is required on top of the evaluation.
Expense reimbursements (Section 22): The Minister of Health, with the authorization of the appropriat e
parliament committee, will decide on a fixed sum that the State will pay to the donor as compensation
for loss of income that reas onably results from the organ donation procedure, as well as decide on
conditions for the reimbursement of expenses such as 1) purchase of a private medical insurance,
insurance for loss of capacity to work or to earn a living, life insurance; 2) psychological treatment; 3)
convalescence leave of absence, all for a determined time and amount (the sum for kidney transplant
is about 3,350 Euros). Payment will be carried out after the trans plantation and is not trans ferable to
another person. The Minister will bestow a certific ate of gratitude to the donor, who will also receive
free entrance to national parks.
Procedure for postmortem organ donations. Patients in need of an organ transplant will be
registered in the NCOT data bank for the purpose of finding a suitable organ donated from the
dead. The application form will indicate whether the patient has himself given consent for organ
donation after death, whether a first-degree relative was a post-mort em donor, or whether he or a
first-degree relative donated an organ from the living to an unidentified recipient.
The director of a hospital in which occurred a deat h compatible with organ donation [see Law on Brain -
respiratory death], and after the legal requirements for organ harvest are fulfilled [consent given before
death by signing an organ donor card, authorization from close relatives], will inform the NCOT director
who in turn will identify a suitable recipient from the data bank, acc ording to the rules set out by the
NCOT steering committee (see above).
Organ donor card: By law, the NCOT has the authority to receive (by itself or through a recognized
organism) the consent of a living person to donate organs after death for the purpos e of transplantation
and likewise the consent of that person that a compensation be given to a relative of his, in return for
the donation.
Incentive for postmortem donation (section 29). An organization especially accredited by the Minister of
Healt h for this purpose, is authorized to give to a living person or to a relative, a reward for the person's
consent to donate organs aft er death, or for the relative's consent that organs be taken from the body
of the deceas ed. The form of reward will be specified in the Minister's accreditation of the organization
and published in the Official State Record [the int ention of the law is for example advantageous
conditions given by an HMO, or other health or social security service]. The Minister can decide that
rewarding of a relative will not be done unless the donor had agreed during his life that such a reward
be given. (Law adopted March 24, 2008, going into effect May 1, 2008).
TURKEY (2008)
The recent developments in the field of Health Law in Turkey includ e the creation of:
(a) the Outlines of a new “Draft Law on Organ, Tissue and Cell Transplants” and
(b) the current “Bylaws on Banking for Umbilical Cord Blood” (under revision).
(c) Moreover, the Ministry of Health has informed me that a Working Group composed of experts
has been working to revise some current laws (Kanun), regulations (Tüzük), bylaws (Yönetmelik)
and communiques (Teblig) on healt h field. The documents are only available in Turkish.
For the Turkish texts of the Health Legislation in Turkey pls see www.saglık.gov.tr or
www.ttb.org.tr. Moreover to obt ain det ailed information on the abovementioned legislation you
can contact Dr. Zeynep Coskun, Head of the Division for Tissue and Cell Transplant at the
Directorate General for Treatment Service, Ministry of Health (Saglık Bakanlıgı, Tedavi
Hizmetleri Genel Müdürlüğü Doku ve Hücre Naklı Subesi), Sıhhıye, Ankara, TR (Phone: 90 (312)
585 1509; 0505 914 6065; Email: zeynepcoskun2008@gmail.com.
ISRAEL (2007)
Period October 2006 to November 2007
Organ transplantations
a) Legislation : The Israeli parliament (Knesset) is preparing a Law on Organ transplantation to
regulate the operation of the Center for Organ transplantation at the Ministry of Health. The Law
addresses both donations from living donors and from the deceas ed (brain-death). The Law deals
with regulations (e.g. to ascertain free informed consent from living donors and avoid any
commercialization, to give first degree relatives t he right to oppose taking organs from a
deceased), and also addresses the question of how the number of organ donations can be
increased. Whereas no financial transaction is allowed, some State -administered compensation
for living donors is considered. The form of compensation is still being debated, as well as the
possibility to extend incentives to families that agree to donate organs from deceased. Another
Law proposal defines medical brain-death, and has recently received agreement from religious
authorities.
b) Bioethics: The Israel National Bioethics Council was asked to consider a proposal to increase
the number of citizens holding an organ donation card indicating their agreement that organs
could be tak en aft er death. This is called in Israel the "Edi" card, and is pres ently proposed to all
citizens by being attached to the fo rms sent for periodical renewal of the driving permit.
Nevertheless, the number of card holders in Israel is still low in comparison to European countries
or USA. Increasing this number is important because when a deceased was a card holder, the
family almost always agrees to organ donation. In contrast, when the deceased had not
expressed during his lifetime his willingness for organ donation, more than half of the families
oppose the taking of organs after death. Several proposals for increasing the number of Edi card
holders were considered. One proposal is to give some form of priority to card holders in case
they would themselves require an organ transplantation. This priority would be limited in time (to
minimize as much as possible the delay for non -holders), and the priority would be given only to
long-time card holders. Moreover, in case of medical emergency requiring quasi-immediate organ
transplant, non-holders will have the same priority as holders. Hence, the priority to card holders
would be only in relation to non-holders who are in the same medical condition, that being a
condition which permits to delay the organ transplant. Finally, the priority would be given only to
card holders, and not to families of donors (i. e. not to families that have agreed to donate organs
of a deceased).
Nevertheless, this incentive by priority raises ethical question because many feel t hat decisions
on whom receives an organ should be purely medical and not subject to whether or not the
patient was ready himself to donate organs. As an alternative way to increase organ donation, it
was decided to re-examine the "presumed cons ent" or "opting-out" option, in which it would be
permitted to take organs from a dec eased if he did not state his opposition during his lifet ime, and
if first-degree family members do not object. In the past, the assumption of presumed consent did
not seem acceptable in Israel, but due to more information about organ shortage and about the
moral duty of saving patient 's lives through organ donation, it is felt that the public opinion may
have changed in relation to the opting-out system.
UNITED KINGDOM (2007)
Human Tissue Authority: new Code of Practice
The Human Tissue Aut hority conducted a consultation between October 2006 and Janua ry 2007
on a code of practice on the import and ex port of human bodies, body parts
and tissue. A post-consultation version of the Code will be available shortly.
Full information about the Human Tissue Act, the Human Tissue Authority and its Codes of
Practices and licensing proc edures, are set out on its website at http://www.hta.gov.uk .
Organ Donation Taskforce
Last year, Ministers established an Organ Donation Taskforce to consider options for
improvement of organ donation rat es within existing legal frameworks. The initial report of the
Taskforc e has just been presented to Ministers who are considering their response.
Organ Donation Taskforce – pre sumed consent
In his 2006 Annual Report On the state of public health published on 17 July 2007, the Chief
Medical Offic er recommended that:
legislation be amended to create an opt-out system for organ donation
more opportunities be taken to increase donation in hospitals and to maximise organ
transplantation
there are t argeted campaigns aimed at increasing organ donation in ethnic minority
populations
As this Report was published, Alan Johnson said that a subgroup of the Organ Donation
Task force would be established to „examine the potential impact on organ donation of int roducing
an “opt out” or presumed consent s ystem in the UK, having regard to the views of the public and
stak eholders on the clinical, ethical, legal and societal issues‟.
The reason for asking a new subgroup of the Taskforce to look at the question of presumed
consent was to:
fully understand the role of presumed consent in driving up donation rates in those countries
that enjoy high rates, and the potential impact on donation rates in the UK.
factor in religious and faith community views as to how such a system would be received.
For example, some areas of the B angladeshi community in East London have extremely high
refusal rates – need to understand this, and the wider context. The Taskforc e could address
this.
to be sure that any plans would be on a firm footing to stand up to Parliamentary and public
scrutiny as legislation would be required.
UNITED STATES (2006)
Organ transplantation: Along with other countries, the United States is struggling with a
chronic shortage of organs. Although there has been some pro gress in increasing the supply,
potential recipients continue to die while waiting for organs, prompting discussions about the
ethics of using incentives. In the United States, the National Organ Transplantation Act of 1984
bans “valuable consideration” in organ procurement and allocation. In May 2006, the Institute of
Medicine, a branch of t he National Academies, issued a report calling for new strat egies and
initiatives to increase donation, but rejecting any change in the current law, including the use of
incentives.
The P resident’s Council on Bioethics is currently conducting a far-reaching inquiry into organ
transplantation with the aim of issuing a report in early spring of 2007; representatives of key
groups within the trans plant community and the medical profession have testified before the
Council and its staff as part of a broad -bas ed effort to canvass the opinions and
recommendations of various constituencies. It is import ant to note that these developments have
occurred against the backdrop of inc reas ed reports of unethical as well as illegal trafficking in
organs and the exploitation and coercion of potential donors worldwide.
More information on this topic is available at: http://www.iom.edu/CMS/3740/24738/34249. aspx
http://www.bioethics.gov/topics/organ_index.html
CYPRUS (2006)
Please note the following Laws and Regulations related to Bioethical issues t hat are currently in
force in the Republic of Cyprus:
The Republic of Cyprus has ratified the Oviedo Convention through the adoption of the Law “The
Convention for the protection of Human Rights and Dignity of human being with regard to the
application of biology and medicine (Ratification Law) and other provisions related to the
application of the convention Law 31(ΙΙΙ)/2001”
Trans plantation of Organs and Tissues of Human Origin Law of 1987 -1999 [L.97/87-5(I)/99]
(a) The Law on the essential requirements to be fulfilled by specific product categories
(b) The Law on the essential requirements for the use and applic ations of medical devices (Κ.Δ.Π
598/2003 and Κ.Δ.Π 599/2003)
The above mentioned laws and regulations provide that the Cyprus National Bioethics Committee
is the authorized body for the bioethical review of biomedical research on human beings for the
clinical trials on medicinal products for human use for clinical trials and medical research using
medical devises.
In accordance with the above laws and regulations the Cyprus National Bioethics Committee has
the authority to delegate the above authority to other suitable bodies.
The National Bioet hics Committee has delegated this authority to subcommittees and monitors
the bioet hical review they perform.
On the 30th of July 2006, the Council of Ministers has appointed the members of the new Cyprus
National Bioethics Committee, who will serve for four years until the 30th of July 2010.
WHO (2006)
Biotechnology Ethics
Transplantation: In response to World Health Assembly Resolution 57. 18, ETH is continuing to
work with the Department of Essential Health Technologies (EHT/ HTP) on updating and
expanding the "Guiding Principles on Organ Transplantation" (1991). Two regional consultations
were held in November 2005 in Manila (for the Asia and Western Pacific regions) and in Karachi
(for the Eastern Mediterranean region). For more information, please see
http://www. who.int/gb/ebwha/pdf_files/EB113/eeb11314.pdf .
UNITED KINGDOM (2006)
Human Tissue Act
The Human Tissue Act - http://www.legislation.hmso.gov.uk/acts/acts2004/20040030.htm -
received Royal Assent on 15 November 2004. The Act covers t he removal, retention and use of
human organs and tissue from the deceased, and ret ention and use of such material from living
patients, for health-related purposes such as transplant ation and medical research. It includes
provisions for c onsent as the underlying principle, for a regulatory framework and for penalt ies
where cons ent is not obtained. It applies in England, Wales and Northern Ireland, with the
exception of a new offence of having human mat erial with the intention of analysing its DNA
without consent, which also applies in Scotland.
Scotland has its own human tissue legislation, t he Human Tissue(Scotland) Act 2006, which
received Royal Assent on 16 March 2006 and will come into operation on 1 S eptember this year.
It deals specifically with organ donation and transplantation from both the living and the dead,
with hospital post-mortem examinations and anatomical ex aminations. Its fundamental principle
of authorisation, which equates to consent under the 2004 Act, emphasises the importanc e of
respecting aft er death the wishes people express during life on this range of issues.
The remit of the Human Tissue Aut hority does not generally extend to Scotland, but by
agreement wit h the Scottish Ministers it will act as the competent authority for Scotland under the
EU Directive on the S afety of Tissue and Cells, as well as dealing with all cases of living donation
involving Scotland.
BOS NIA AND HERZEGOVINA (2006)
It is a fact that medical science as well as practice, like other biological science are becoming
more riscant and dehumanized and more impersonal, and from that reasons legislation in B osnia
and Herzegovina are putting bigger pressure on recognition of individual rights on self-
determination and reformulation of guarant ee of patients other law.
Taking Universal declaration about human rights, European Convention about human rights and
equality, as well as declaration about patient rights as starting point, Law of Health care regulat es
inalienable rights of patients-citizens. By this Law it is predicted that citizens have rights on
standard quality and the same content of health care, as well as rights on compensation in case
that inadequate health care and professional mistake are proved. The Law regulates the
procedure for realization of above mention rights.
It is regulat ed by the Law of transplantation of parts of human body in purpose of healing, that
taking and replanting parts of human body could be performed only in case of medical justification
or in case when that is the best way of healing.
Law is also regulating transplantation from leaving donor and dead person-cadaver.
In accordance with above mention law, nonliving donor could be adult, working and healthy
person. Rarely, that donor could be underage pers on in case of donation of bone marrow.
Taking a part of body could be performed only in case if that procedure not putting human life in
danger, and if it is not risk of permanent defect of human health. Medical doctor who is
performing transplantation need to inform in written the donor and receiver of organ about
possible risks on their health, and about possibility of success of such kind of treatment. Also, the
doctor needs to have their written cons ent.
The written consent should be cancel/recall until the surgical treatment has started.
In cadaver transplantation all are potential donors except in a case when person rejected it during
life and gave written rejection
In a case that dead person was underage or ment ally disabled, the written rejection could be
given by the parents, marital partner or adult kid or tutor. H owever, besides written consent the
explanation cannot start without written consent given by the family, and before the cerebral
death has been confirmed in accordance with medical criteria and formal procedure.
An unallowable transplantation part of hum an body is criminal activity and defined by Criminal
Law.
Law about conditions and procedure for pregnancy interruption are regulated and guaranteed
rights within this area. Freedom of decision-making is guaranteed by this law, and mans and
women have right on any kind of professional advice regarding reproductive health.
UNITED KINGDOM (2005)
Human Tissue Act
The Human Tissue Act - http://www.legislation.hmso.gov.uk/acts/acts2004/20040030.htm -
received Royal Assent on 15 November 2004. The Act covers t he removal, retention and use of
human organs and tissue from the deceased, and ret ention and use of such material from living
patients, for health-related purposes such as transplant ation and medical research. It includes
provisions for c onsent as the underlying principle, for a regulatory framework and for penalties
where cons ent is not obtained. It applies in England, Wales and Northern Ireland, with the
exception of a new offence of having human material with the intention of analysing its DNA
without consent, which also applies in Scotland.
The Act:
provides a consistent legislative framework for issues relating to whole body donation, and
the taking, storage and use of human organs and tissue
makes consent the fundamental principle underpinning the lawful storage and use of human
bodies, body parts, organs and tissue and the removal of material from the bodies of
deceased persons
sets up an over-arching authority (the Human Tissue Authority) to rationalise existing
regulation of activities like transplantation and anatomical examination, and to introduce
regulation of other activities like post mortem examinations, and the storage of human
material for education, training and research
achieves a balance between the rights and ex pectations of individuals and families, and
broader considerations, such as the importance of research, educ ation, training, pathology
and public health surveillance to the population as a whole
Other Topics Concerned: Biomedical Research
SWEDEN (2005)
The Government has presented a proposal to the Riksdag on an amendment to the Transplants
Act to the effect that hospit als where potential donors are treated have access to a doctor in
charge of donations and a nurse responsible for c ontacts with relatives. These will have the task
of preparing organ and tissue donations and providing support and information to the bereaved
families. A National Council for Organ and Tissue Donation will be established at the National
Board of Health and Welfare. The Council will function as a knowledge bank and will form opinion
and disseminate information on donation and transplantation issues to the general public. In the
contract between the state and the National Corporation of Swedish Pharmacies, the
Government wis hes to include national res ponsibility for supplying information on transplantation
and organ and tissue donation. These proposals are to be found in t he Government Bill
Trans plants save lives (2003/04:179). The Riksdag has approved the proposal on the
amendment to the Transplants Act.
Fact sheet on Government Bill 2003/04:179, Transplants save lives:
http://www.sweden.gov.se/content/1/c6/03/29/30/bff8a3be.pdf
WHO (2005)
Human organ and tissue transplantation
In response to World Health Assembly Res olution, the Department of Ethics, Trade,
Human Rights, and Health Law (E TH) is working with the Department of Essential
Technologies to update the 1991 "Guiding Principles on Organ Transplantation".
Regional consultations will be held in November 2005 in the Western Pacific and E astern
Mediterranean regions.
WHO participates in the newly formed Global Alliance for Transplantation which seeks to
improve knowledge and good practices. Particular emphasis is now being placed on
development of a registry for transplant outcomes (with regular follow up), encompassing
both organ recipients and living donors.
GEORGIA (2004)
Georgian Legislation Related to Bioethics
Legislation of Georgia related to bioethics comprise texts which regulate various aspects of
medicine/ health care: rights of patients and research s ubjects (including vulnerable groups; such
as minors, persons wit h mental disorders, patients with HIV/AIDS etc.), duties and responsibilities
of health care professionals, human organ transplantation, assisted reproductive t echnologies
etc.
Below in the table the list of laws (which are on different stages of preparation/adoption)
related to bioethical issues are given. From these laws the Law of Georgia on Health Care is
considered to be the framework law, which determines the priorities and sets out fundamental
principles of the health care legislation of Georgia.
Table 1. Laws on the different stages of preparation/adoption (1995-2004)
BEFORE
BEFORE
GOV ERNMEN ADOPTED LAST UP DATE
PARLI AMENT
T
The Law on Medical Activity 2001 (08.06) 2001 (26.10)
The Law on the Rights of Patient 2000 (05.05)
The Law on Human Organ
2000 (23.02) 2002 (21.11)
Trans plantation
The Law on Protection and
Promotion of Infant Nat ural 1999 (09.09) 2000 (09.06)
Feeding
The Law on Health Care 1997 (10.12) 2003 (18.07)
The Law on Drug and
1996 (25.12) 2003 (8.05)
Pharmaceutical Activity
Since 2002
The Law on Psychiatric Care (New 1995 (21.03) 1999 (24.12)
amendments)
The law on HIV/A IDS Prevention 1995 (21.03) 2000 (08.11)
The Law on Abortion Since 2000
The Law on Biomedical Res earch
Since 2001
Involving Human Subjects
The Law on Reproductive Health
2003
and Reproductive Rights
Legislation Concerning Human Organ Transplantation
Legislation on human organ t rans plantation is composed of Law on Health Care (Chapter
XX “Removal and Use of Human Organs, Parts of Organs, Tissues”), Law on Hum an Organ
Trans plantation and corresponding articles of the Convention on Human Rights and Biomedicine.
The aim of the above legislation is to establish the safe practice of human organ
transplantation in the count ry and to protect human rights in this sphere.
The main principles of Georgian legislation on human organ transplantation are as follows:
- Prohibition of financial gain;
- Restricting the donors’ circle t o genetically related relatives and spouse; However,
1
allowing so called cross donorhood ;
- Establishment of opting-in model (expressed consent model) of organ retrieval from
deceased persons;
- Prohibition of organ removal from the unsupervised body, whose wishes are not
established.
After the Law on Human Organ Transplantation entered into force (23.02.2000) several
normative acts (President’s Order and Orders of the Ministry of Labour, Health and Social A ffairs
and t he Ministry of Justice) were prepared to define brain deat h criteria, procedures for importing
and ex porting human organs, procedures for expressing wishes concerning organ removal for
transplantation after death etc.
The full text of the updated version of the Law on Human Organ Transplantation is given in
appendi x 4 (on request).
Other Topics Concerned: Biomedical Research, Patients’ Rights, Genetics, Reproductive
Rights
LITHUANIA (2004)
Amended Law on Human Tissue, Cells and Organ Donation and Transplantation came int o force
in March 2004. New provisions regarding t he use of human cells as well as banking of human
tissues have been introduced in this edition of the law (the mentioned issues were not covered in
the previous version of the law).
NETHERLANDS (2002)
Foetal Tissue Act
Tissue that becomes available after a miscarriage or abortion can be used for various medical
purposes, including the treatment of patients with certain diseases.
The Organ Donation Act prohibited the use of parts of a human foetus for transplantation
purposes. The reasons were that this was a sensitive issue and that such transplant ations were
as yet unknown in the Netherlands. A number of years have passed since then, however.
Various health care organisations expressed their concern about the ban. People with
Parkinson's disease, for example, might benefit from treatment with foetal tissue. The Health
1
Cross donorhood is defined by the Law on Human Organ transplantation as follows: “T aking organ from a spouse of a potential
recipient or genetic relative for transplanting into another potential recipient and, relevantly, taking the same organ from the spouse of
the second potential recipient or a genetic relative for transplanting into first potential recipient ”.
Council too held the view that the ban was obstructing the development of promising applicat ions.
Treatment of patients with DiGeorge Syndrome, a serious but fort unat ely rare congenital
developmental disorder, was by this stage possible but prohibited. The government therefore took
the view that the ban should be lifted.
Using foet al tissue for purposes other than transplantation (for medical res earc h for instance) was
not prohibited in the Netherlands, but neither was it regulated by law. In view of the sensitive
nature of the issue and the exceptional circumstances under which foetal tissue bec omes
available, statutory rules ensuring that procedures would be carried out with due care were
considered desirable.
The Foetal Tissue Act specifies the purposes for which foet al tissue may be used and the
conditions for such use. Foetal tissue may only be used for medical purposes or medical and
biological education and research. The woman in question must always give her written consent,
she must always be informed in advance of t he purpose and must be free to make her own
decision. Possible uses for foetal tissue may not influence a decision regarding termination of a
pregnancy. The provision of information and request for consent may therefore only take place
after any such decision has been taken. What is more, in order to prevent conception for this
specific purpose, women may not designate the persons who are t o benefit from the tissue.
Finally, the Act prohibits payment for making foetal tissue available.
DENMARK (2002)
Committee on Gene Technology
The ad hoc Committee on Gene Technology was set up in cons equence of a debate in the
Danish P arliament in January 2001. The c ommitt ee was given the t ask of describing potential
benefits and risks relat ed to t he cloning of stem cells, x eno trans plantation, gene therapy and
genetic testing of healthy individuals. The committ ee was not ask ed to prepare legislation.
Jointly wit h the Minister for the Int erior and Healt h and the Minister for Justice, the Minister for
Science, Technology and Innovat ion was given the task of appointing the c ommittee.
The c ommittee has covered the following questions:
> What are the pot ential benefits and risks of using st em c ell therapy, xenot ransplant ation,
gene therapy and genetic testing of healthy individuals?
> Considering t he future application of t hes e emerging t echnologies, which problems are
important to c onsider? How c ould these problems be s olved and who s hould cont ribute
to the task of problem solving?
Based on the c urrent leading-edge science wit hin t he four areas, as well as t he et hical aspects
and the legislative matters, the committ ee points to a number of problems that should be
addressed as a prerequisite for fut ure applic ation of the new technologies.
Stem cell therapy:
Stem cells are the „primordial cells“ of human beings and t hey have the abilit y to differentiate
into all t he ot her types of cells. Thus, the vision is that the use of stem cells will mak e it
possible t o repair for inst ance nerve cells t hat have been destroyed in patients suffering from
Parkinson’s disease or repair liver cells in a malfunctioning liver.
Today, it is ass umed t hat stem cells obt ained from the human embryo have the great est
potential. However, there is increasing evidence that adult stem cells e.g. from cord blood and
fully developed tissue might, if properly treated, ex hibit a potential similar t o the pot ential of
embryonic stem c ells. Bot h nationally as well as internationally, att ention is foc used on
embryonic stem cells. The major conc ern is whether the possibility of developing new medical
treatments can justity the et hical doubts relat ed to the isolation of stem cells from the embryo.
The is olation of stem cells is permitted in, for instance, Sweden and the United Kingdom.
Whereas in Germany, for instanc e, and in the United Stat es as far as federally financ ed
research is conc erned, only researc h on already existing stem c ell lines is permitt ed.
In Denmark the sit uation is not clarified. The field is regulat ed by t he Act on Medic ally Assisted
Proc reation. Stem c ells are not mentioned directly in the Act. However, it regulates t he
utilisation of t he human embry o in a researc h cont ext. Only research whic h aims at improving
the IV F treatment and pre-implant ation diagnosis is permitted, and only when using embryos
left over from the IVF t reatment. According to government interpret ation the act does not
restrict research performed on imported st em c ell lines. This matter has not been t aken to
court.
Independent of Parliament’s wish eit her t o widen the possibilities of carrying out researc h on
embryonic stem cells, or to maintain or to further limit the current possibilities for suc h research,
the c ommitt ee finds that t here is a need to clarify existing regulation t rough a legislative
revision.
It i s recommended
> that parallel with a public debate, political clarity co ncerning the us e of embryonic stem
cells be established as soon as possible. On t his basis and if needed, a legislative
preparatory work should be initiat ed, also with a view to a revision of t he Act on Medically
Assisted Proc reation.
Seven k ey questions require political res olution:
1) S hould i t be permi tted to derive stem cell s from fertili sed eggs/embryos left over from
an IVF treatment with the aim to perform ba sic re search on stem cell s and to explore the
possibilitie s of new treatments?
Today, the Act on Medically Assisted P roc reation does not allow the utilis ation of human
embryos for researc h purposes unless the purpose is to improve t he IV F treatment or methods
for pre-implant ation diagnosis.
Should t here be a political wish for establishing the possibility of employing embry onic stem
cells, it would require an amendment to t he Act on Medically Assisted Procreation.
If suc h an amendment is adopted, Parliament should also decide whet her there is a need for
special approval schemes.
2) Should the fertili sa tion of eggs by means of IVF technique be permitted even though it
is not part of a fertili sation treatment?
Fertilisation of an egg solely for the purpose of the formation of embryos for res earch purposes
is, as mentioned above, not permitted at present. Should there be a politic al wis h to allow this
procedure, it would require an amendment to t he Act on Medic ally Assisted P rocreation and an
amendment to Denmark’s ratific ation of t he Convention on Human Rights and Biomedicine of
the Council of E urope.
If suc h amendments are adopt ed, P arliament should also decide whet her there is a need for
special approval schemes.
3) S hould the formation of embryos through nuclear transfer from somati c cell s be
permitted?
Today, the formation of embryos thro ugh nuclear trans fer from a somatic cell to an unfertilis ed
egg is not permitted for research purposes.
Should t here be a political wish for allowing nuclear trans fer, it will require an amendment to t he
Act on Medic ally Assisted P rocreation and an amendment to Denmark’s ratific ation of t he
Convention on Human Rights and Biomedicine of t he Council of Europe.
If suc h amendments are adopt ed, P arliament should also decide whet her there is a need for
special approval schemes.
4) Should there be spe cific rule s for the use of embryonic stem cell lines?
If the derivation of stem cells from the embry o is permitted through an amendment to the Act on
Medic ally Assisted Procreation, self-renewing stocks of t hes e cells (stem cell lines) may be
creat ed.
If thes e stem cell lines are regarded as being equal t o cells isolated from other tissues, the
utilisation in res earch and in industry will be c overed by general acts and rules. However, if
these cell lines are regarded as being different from ot her c ell lines, ther e will be a need for
setting up specific rules concerning t he use of the cells.
5) Should speci fic rule s apply with regard to information and consent from the
couple s/ the women who might dona te fertili sed and non-fertili sed eggs?
The limited researc h relating to the IVF treatment and pre -implantation diagnosis that is
currently permitt ed on embry os must be approved according t o the rules of t he scientific et hical
committee system.
Provided that possibilities for researc h employing embryos are extended, it should be
considered whet her there is a need for specific rules conc erning information and consent.
6) Should re search on imported embryonic stem cell lines be regulated?
According to the Minist ry of the Interior and Healt h, the Act on Medically Assist ed Procreation
cannot be extended to apply to research on imported embry onic stem cell lines. A possible
need for regulation conc erning the use of import ed embryonic stem cell lines should be part of
a comprehensive resolution in this field.
7) Should the use of adul t stem cell s be regulated further?
At present, adult stem cells may be used for research in accordance with the rules of the
scientific ethic al committee system.
It is possible that in time t here will be a sliding transition between cell lin es produc ed from adult
stem cells and from embry onic stem cells. Provided that regulation on the us e of embry onic
stem cell lines is established, it will t herefore be relevant t o ensure that regulation in this area is
in accordanc e wit h regulation applic able to adult stem cell lines.
Xenotransplantation:
Xenotrans plantation comprises methods of treatment where cells, tissue or organs are
transplanted from animals to humans. The vision for x enotrans plantation is that tissues or
organs from animals - in particular from genetic ally modified pigs - replace malfunctioning
tissues/organs in humans. At present, xenotrans plantation is not offered as a t reatment in
Denmark and t he future importance of applying xenotransplantation in clinical medicine is
uncertain.
From a public health point of view, one of the main c onc erns is the risk of new and unknown
epidemics bas ed on disease transmission from animals to man (zoonosis) and from man to
animals. Thus, t he most import ant question will be t o balanc e the advant ages that this
treatment will offer the individual patient wit h the s ocietal risks of major epidemics among
human beings and animals. In spit e of extreme care, screening of donors and isolation of
recipients, it will never be possible to guarantee the eliminat ion of all risks of trans ferring an
infection.
In Denmark there are at present no clinic al trials related to xenot ransplant ation, but in the event
of an int ernational breakthrough in this field, it may be desirable for Denmark t o participat e in
clinical trials.
Statements from The National Board of Health and the Central Scientific Ethical Committ ee
ensure that no t reatment involving x enotrans plantation is permitted and t hat
xenot ransplantation should be performed solely as part of a res earch project and only after a
permission has been granted by the Danis h Central Scientific Ethic al Committee.
The ad hoc Committ ee on Gene Tec hnology finds t hat t his field is at pres ent s ufficiently
regulated.
It i s recommended
> that the present restrictions are maint ained. However, in the event of an international
breakthrough this should be reassessed.
Gene therapy:
Gene t herapy is based on t he int roduction of genes into the cells of a patient - eit her to replace
diseased genes or t o adjust the production of cellular proteins.
Early high hopes of applying this tec hnology or treatment have been replac ed by more cautious
assessments, but gene therapy is none the less seen as holding important promises for
treatment of conditions such as inherited disorders as well as cancer and cardiovascular
diseases.
The most essential problems relat e to engineered virus es that are often employed t o introduce
the genetic material. One concern is t hat the us e of virus may involve a risk of inducing or
transmitting infections. Gene t herapy is covered by the existing legislation. The committee finds
that at present t here is no need for any furt her regulation.
It i s recommended
> that gene therapy as a field of res earch and treatment should be monit ored wit h a view to
its possible future introduction in clinical medicine. This applies t o bot h possible new
breakthroughs, questions of side effects and possible future needs for regulation.
Genetic te sting of healthy individual s:
Genetic testing is used in the Danish health services today, and it is expected that its use will
increase in the years to come. The committee has in particular been conc erned wit h tests
involving analyses of DNA or t he related RNA.
Analyses of DNA/RNA will increas e the k nowledge conc erning genetic predisp osition for
development of diseases lat er in life. At the same time such analyses are lik ely to establis h a
new paradigm, allowing for genetic couns elling, prevention and treatment of diseases that are
far more individualised than we know today.
However, a number of challenges and problems are related to genetic testing of healthy
individuals. Firstly, it is important to secure the right of citiz ens who prefer „not to k now“.
Secondly, it is anticipat ed t hat t he increasing number of genetic tests will result in an increas ed
need for couns elling. Thirdly, commercial as pects of offering thes e t ests outside t he authoris ed
or established medical laborat ories or clinics might in some cases outweigh the regards for
proper c ounselling as a prerequisite for testing.
The int roduction and use of genetic tests are regulated just as any other kind of diagnostic t est
used wit hin t he health s ervic es or offered on the mark et. The Danish acts regulating this field
are the Act on Hos pital Services, the Act on the Practice of Medicine, the Act on the Rights of
Patients and finally the Act on medic al utensils implementing the „in vit ro directive“ that covers
approval, including approval of genetic t ests to be market ed in the E uropean Union. The
committee finds that the major problem within this field relat es to the c ounselling of the
individuals both before as well as after genetic testing has been performed.
It i s recommended
> that the need for couns elling of the pers on to be tested should be ass essed in the light of
fut ure developments in this area. The capacity for genetic counselling s hould be matched
to meet future demands.
Other Topics Concerned: Cloning, Human Genetics
UNITED KINGDOM (2002)
In May 2002, The Human Genetics Commission (HGC) published 'Inside Information: Balancing
interests in the use of personal genetic dat a', its report on the storage, protection and use of
personal genetic information. Its main recommendations included: making a criminal offence of
testing a person's DNA for non-medical purposes without their knowledge or consent; introducing
measures to protect individuals from unfair genetic discrimination; and implementation of robust
and transparent arrangements to balance the int erests of individuals against those of medical
research or forensic science.
The primary foc us of HGC's current work is a review of the regulation of genetic testing services
supplied direct to the public, recommendations on which was requested by Ministers for the end
of the year. The deadline for respons es to the associated consultation was 4 October, and
evidence is still being gathered from a range of sources, including meetings with relevant/
interested organisations, focus groups and innovative Internet technologies. Issues being
considered include: whether genetic test results should be treated differently from other health -
related information a pers on might have direct access to; the possible control of genet ic testing
services available via the Internet; and the possible right of people to obtain whatever information
they want about themselves. More information can be obtained from the HGC website at
www.hgc.gov.uk
In July 2002, the Government issued a consultation document concerning the reform of the law
governing the taking, storage and use for any purpose of human organs and tissue, from the
living and the dead (including stillbirths and fetuses ). The report Human Bodies, Human Choices
is available at www. doh. gov. uk/tissue. Consultation closed on 14 October 2002. The Government
is also developing a Code of Practice on the import and export of human body parts, and consent
forms and a Code of Practice concerning post-mortem ex aminations; information about this work
is also available on the tissue website
Other Topics Concerned: Human Genetics
GEORGIA (2001)
The law about organ transplantation was adopted by Georgian Parliament in February 2000. In
February-March 2001, Georgian Government adopted and President signed the doc uments
about “Regulations of Export and Import of Human Organs”.
According to the law and regulations:
Georgia participates in organ transplantation international practice
only those organs are allowed for import taking, processing and validity confirmation of
which were performed in compliance with the requirement of the respective country laws,
which shall be reflected in the accompanying documents
the right to export the organ to Georgia is authorized to the institution possessing a
relevant license
the unimpeded delivery of the human organs to the territory of Georgia is performed
basing on special application pro vided by the institution possessing a relevant license
and documents accompanying the organ
general surveillance on the usage of imported human organs is performed by the Ministry
of Labour, Health and Social Protection of Georgia
export of the human organs from Georgia is allowed only under the permission of the
Ministry of Labour, Health and Social Prot ection of Georgia via Transplantation Bank
Other Topics Concerned: Patients’ Rights
Human Brain Death Criteria
The death of the individual implies irreversible termination of the functions of all
structures of heart and respiratory system or brain (including brain stem ).
The following are the major causes of brain death: severe trauma of the brain; hemorrhage
developed as a result of cerebral aneurysm rupt ure; large-size ischemic cerebral insult
complicated with brain edema and incarceration and other cerebral pathologies.
Ischemic encephalopathy and brain edema due to other extrac erebral causes developed as a
result of cardiac arrest or asphyxia can also be the cause of brain death.
1. The following are prerequisites of the brain death diagnosis:
a. Presence of medicine induced or ot her int oxication of exogenous origin;
b. Presence of hypothermia (reactive temperature of the body shall not be less than
0
32 C);
c. Presence of hypotension (systolic arterial blood pressure shall not be less than
80 mmHg).
2. The following are the criteria of the brain death:
a. Coma the depth of which is 3 points by Glasgow coma s cale;
b. Presence of the brain stem reflexes (pupil photoreaction, oculocephalic,
oculvestibular, corneal, tracheophariyngeal);
c. Presence of the spontaneous breathing confirmed using special “Apnoe” test.
The brain deat h shall be c onfirmed electroenceph alographically or by transcraneal ult rasound
Dopplerohraphy.
Tests to confirm the brain death shall be performed twice with 12 hour interval between tests, and
in case of a child up to one year these tests shall be performed three times with 48 hour inter val
between the tests. The comprehensive description of the t est methods is envisaged in the
guidelines “On the Methods of Brain Death Clinical Diagnosis and Testing”.
Guidelines
On The Methods of Brain Death Clinical Diagnosi s and Paraclinical Studies
I. Prerequisite s for Brain Death Diagnosing
1. To diagnose brain death it is necessary t o state the cause of the brain death. At the same
time the impact on the organism of such factors as intoxication of medicinal or of ot her
exogenous origin, hypothermia, hypovolemic shock, metabolic or endocrine coma, as well
as the background use of narcotic substances and myorelaxation drugs, shall be excluded.
°
2. Rectal temperature of the patient shall be at least 32 C, systolic arterial blood pressure
shall be at least 80 mm Hg.
II. Mandatory Clinical Criteria to Diagnose Brain Death
1. Absence of consciousness. Coma, the depth of which is 3 points by Glasgow coma scale.
2. Atony of all muscles. Absence of any response to the strongly painful stimulation of the
trigeminal area.
3. Absence of photreaction of the pupil to the bright light provided not pupil dilatators were
used.
4. The eyeballs are motionless.
5. Absence of the corneal reflexes.
6. Absence of the oculocephalic reflexes:
a) On contralateral turning of the head bent in the maximally lateral position the eyeballs are
fixed and do not change their position (“Doll’s eyes” sign);
b) Oculocephalic reflex is not checked if there is traumatic injury of the cervical part of the
spinal cord or such injury is suspected. Non-conduction of this test due to the above reason
does not testify against the brain death diagnosis.
7. Absence of oculovestibular reflexes:
a) Before testing it is necessary to check for the integrity of the tympanic membrane. In cases
when the integrity of the tympanic member is impaired the test shall not be conducted.
Non-conduction of this test due to the above reason does not testify against the brain death
diagnosis;
0
b) The head of t he patient shall be bent forward by 30 from horiz ontal position. Small size
catheter is placed into the external auditory tube and slowly irrigate with continuous flow of
0 0
cold (+ 4 - +8 C) wat er during 10 s econds. If the brain stem functions are absent the
eyeballs remain motionless.
8. Absence of the pharyngeal and tracheal reflex es:
This is stated by the absence of cough reflex in the course of moving of the endotracheal
tube in the trachea or upper respiratory ways or moving the catheter while aspirating the
sputum.
9. Absence of spont aneous breathing:
On the background of artificial respiration the patient is provided with 100% oxygen during
average of 10-15 minutes until arterial PaO 2 reaches 200 mm Hg. Then t he artificial
respiration apparatus is switched off. 100% oxygen intake continues at 0.1 l/kg/min volume
until Pa CO2 exceeds 60 mm Hg (it t akes about 8-10 minutes to reach this level). If by this
time no signs of spontaneous res piration are evident the apnoe test is considered positive.
which confirms the brain death.
III. Paraclinical Methods to Co nfirm the Diagnosi s of Brain Death
1. Electroencephalography (EE G) or transcranial Dopplerography are the paraclinical
methods to confirm the brain death.
2. The presenc e of electronic activity of the brain is stated in compliance with the
internationally accepted electroencephalographic studies, which are assumed under the
brain death conditions.
3. Any kind of minimum 8 electrodes located following “10-20” system and 2 ear electrodes
can be used. The resistance between the electrodes shall be minimum 100 ohms and
maximum 10 kilohms. The distance between the electrodes shall be at least 10 cm.
4. Recording in t he channels is performed during the constant period of time of at least 0.3
sec with at least 2 microvolt/mm amplification of the signal (the upper threshold for
frequency passage shall be minimum 30 Hz ). Minimum 8 channel recorder shall be used.
EEG is recorded in bi- and monopolar leads. Electronic silence of the cerebral cortex under
the conditions of uninterrupted recording shall continue at leas t during 30 minutes. In all
suspicious cases of the electronic silence of the brain the EEG recording shall be repeated.
5. Estimation of EEG reactivity shall be conducted in response to the impact of light, loud
noise and pain. Duration of the above stimuli is minimum 10 sec. The light source with
frequency range of 1 to 30 Hz shall be placed at 80 cm distanc e from the eyes. Intensity of
the acoustic stimulus shall be 100 decibels. The dynamics shall be located near the ears of
the patient.
6. Maximal int ensity stimuli are generated using standard video- and phonostimulators.
Vigorous pricking of the skin with needles is used to cause pain.
7. EEG, which is recorded via telephone, cannot be used to determine electronic silence of
the brain.
8. Transcraneal Dopplerography is used for bilateral probing of anterior, middle and vertebral
arteries of t he brain. A bsence of the diastolic flow in the presence of the systolic flow
represents the Dopplerographic correlation of the brain death.
IV. Legalization of the Brain Death Diagnosi s
1. The diagnosis of the brain deat h is stated by the two independent commissions of
physicians compos ed of: the patient’s physician, resuscitation specialist, neurologist, (with
at least 5 y ear experience in the field). Other spec ialists can be also included into the
composition of the commission to conduct special studies. Organizational part of the brain
death diagnosis is provided by the head of the clinic (department ).
2. The specialists who participate in removal and t ransplantation of t he organs cannot be
included into the composition of the commission.
3. “Protocol on Stating the Brain Death Diagnosis” is the major document to confirm the
diagnosis. (ref. Attachment 1).
4. Once the brain death diagnosis is stated the resuscit ation activities including artificial
ventilation of lungs can be terminated if the deceased is not a potential donor of organs.
Brain death is identical to human death.
5. All studies to confirm the brain death shall be conducted twice within the period o f 12 hours
and in cas e of the child under 1 year such studies shall be performed three times during 48
hour period.
Law of Georgia
On Taking of Human Organs, Parts of Organs, Ti ssues and Their Usage.
Chapter I
General Provisions
Article 1.
This Law regulates the relations hips bet ween the state bodies, physical and juridical persons in
the sphere of voluntary giving of one or more organs, parts of organs, tissues (hereinafter
referred to as the “organ”), their taking, storing and distribution with t he aim of their
transplantation to other humans both during the lifetime of the donor and after his(her) deat h.
Article 2.
This Law does not regulate:
a) Taking and utilization of blood and its components, embryo and fetus organs, placent a,
reproductive organs (ovaries, testicles, ova, sperm), toot h, hair;
b) Taking of organs to make a diagnosis during the lifetime of the patient or after his (her)
death;
c) The cases of forensic medicine.
Article 3.
The notions and terms used in this Law have the following meaning:
a) Ge ne ti c ki n – the son (daughter), mother, father, grandchild, grandmother, grandfather,
brother, sister, nice, nephew, uncle, aunt, cousin of the donor or recipient;
b) Donor – alive or dead human from whom the organ is taken to transpla nt it to another
human;
c) I nformed conse nt – the consent of t he patient or in case of his (her) incapability of his
(her) relative or legal representative on conduction of a certain medical intervention with
preliminary explanation of t he essence, indications, expected effects, possible side
effects of the int ervention in question as well as the risks related to this intervention;
d) Re ci pie nt – the person to whom the other human’s organ was transplanted as the
course of treatment to restore his (her) health;
e) Typi ng – determination of immunologic indices of the tissues;
f) Tra nspla nta ti on. Orga n transpl a nta ti on – the transplantation of the human organ
to another human to save the patient’s life, cure the patient, hinder the progress of the
disease or improve the quality of life of the patient;
g) Ce re bral dea th – the irreversible cessation of the function of the brain and initial
segments of spinal marrow on the background of artificially (using special medical
means) maintained breathing and circulation.
Chapter II
Voluntariness of Organ Donation
Article 4.
Any capable person has the right to voluntarily declare his (her) consent or refusal on taking his
(her) organ during his (her) lifetime or after his (her) death.
Article 5.
Cons ent or refusal can be related to one or more organs. The decision is legalized in the written
form and is confirmed by the head of the medical institution.
Article 6.
The written consent on organ donation shall be sent t o the Transplantation Information Center,
which is forming the pot ential donors’ database (“The Donors’ Register”);
Article 7.
The health care institutions in accordance wit h the recommendations worked out by in
cooperation with medical professional associations educate the population about the possibi lities
and importance of donation, taking and transplantation of the organs to other humans.
Chapter III
Postmortem Organ Taking in Case of Absence of Declared Consent or Refusal Given
During One’ s Lifetime
Article 8.
Taking of the organ from the deceased with the aim of its transplantation in cases when there is
no consent or refusal declared in writing during the lifetime of the dec eased is allowed if:
a) There are the facts confirming that organ taking does not contradict the religious beliefs
and et hical principles of the deceased;
b) The person of the first priority right as indicated in the order of priority list of persons
provided in A rticle 9 of this Law gives his (her) consent on t aking of the deceased’s
organ.
Article 9.
1. The following capable person have the right to allow or forbid organ taking from
the deceased:
a) spouse;
b) son or daughter;
c) parent;
d) grandchildren, great grandc hildren;
e) sister, brother;
f) niece, nephew;
g) grandmother, grandfather;
h) uncle, aunt;
i) cousin.
2. If even one of the relatives possessing equal rights refuses to give his (her)
consent the organ taking from the deceased is inadmissible.
3. The persons listed in Item 1 of this Article have the right to make decision on
organ taking only if and only if the higher priority person (s) is (are) not alive or if
obtaining the consent from him (her) or them within the period admissible for
transplantation is impossible.
Article 10.
The right to get the consent from the persons listed in Article 9 is given to the medical staff
member of the hospital who has relevant authorization and does not participate in organ taking
and using procedure.
Article 11.
If basing on the accepted medical standards the deceas ed patient is assumed to be a relevant
candidate for organ t aking but he (she) has not given written consent on organ donation during
his (her) lifetime and none of the persons listed in Article 9 of this Law could be found after the
patient’s death, organ taking from the cadaver wit h the aim identified in A rticle 4 of this Law is
inadmissible.
Chapter IV
Taking of Organ from the Deceased Donor
Article 12.
The person can be considered as dead only after brain death or irreversible cessation of
heartbeat and circulation is confirmed.
Article 13.
The criteria for cerebral death and irreversible cessation of heartbeat shall be worked out by the
Ministry of Labor, Health and Social Protection of Georgia in accordance with the international
standards and shall be approved by the President of Georgia.
Article 14.
Brain death of the patient shall be confirmed by the two independent teams consisting of a
resuscitation specialist and neuropathologist basing on the results of separately conducted
investigation with participation of the physician in charge of the given patient. These persons shall
not participate in organ taking or transplant ation and by their official status shall not be
subordinated to the persons participating in organ transplantation process.
Article 15.
The dat e and time of investigation conducted to determine brain death, the data obtained and
those data based conclusion shall be provided in written form and confirmed by the signature of
the investigator physician. The relatives or the legal representative of the deceased have the right
to familiarize themselves with the above conclusion.
Article 16.
The relatives or legal representative of the deceased have the right to attend the organ taking
procedure, and in cas e they do not have such wish, they have the right to get the information on
the conducted procedure from the relevantly aut horiz ed hospital staff member or from the
physician who took the organ.
Chapter V
Organ Taking from Alive Donor
Article 17.
Taking of organ from the alive donor to transplant it to another human is allowed only to save the
life of the patient, cure him (her) from the severe diseas e, hinder the progress of the disease or
improve the quality of life.
Article 18.
Taking organ from the alive donor with the aim of its subsequent transplantation is allowed only in
cases meeting the following requirements:
a) The donor shall be capable, except for the cases envisaged in Article 20 of this Law;
b) The donor and recipient shall be genetic kin or spouses except for the cases envisaged
in Article 20 of this Law;
c) The donor made a written consent on organ donation;
d) The c ontemporary advanced methods of investigation confirm that immediate or remot e,
direct or indirect consequences of the operation do not represent significant risk for the
life of the donor and will not result in mark ed deterioration of the donor’s health;
e) The relevant studies confirm that the donor complies with t he criteria the consideration of
which is mandatory when taking the organ for transplantation from the alive donor;
f) The operation aimed at taking of organ shall be conducted by the physician possessing
adequate license and in the institution having the relevant license.
Article 19.
Taking of t he organ, which can be regenerated, from t he alive donor to transplant it to other
human being is allowed in those cases also when the donor is not a genetic kin or spouse.
Article 20.
Taking of bone marrow from the under age person (except for juvenile donors) t o transplant it to
another person is allowed if:
a) Taking of bone marrow will not effect the health of the donor, which shall be confirmed by
two independent physicians possessing relevant license;
b) Bone marrow shall be transplanted to t he relative of the first or second order whose
health is jeopardized and no other therapeutic option exists;
c) The attitude of the under age person towards the proc edure allows medical intervention;
d) The informed consent confirmed by the guardian and care bodies is provided from the
legal representative in case of under age person deprived of par ental care.
Article 21.
To obtain the informed consent from the potential alive donor the following shall be explained to
him (her):
a) The kind of surgical intervention required for taking of organ. its volume, risk for life
entitled with this operation, possible immediat e and remote, direct and indirect impacts of
operation on the donor’s health;
b) Expected results from transplantation of t he organ taken from alive donor including
success and failure possibilities;
c) All possible circumstances, which can effect the donor’s decision.
Article 22.
Explanations provided in Article 21 of this Law shall be given to the pot ential donor by the
physician possessing relevant license and in the presence of another physician who does not
participat e in taking and t ransplantation of the organ and who at the same time b his (her) official
status is not subordinat ed to the physician participating in organ transplantation. The explanations
provided t o the donor and his (her) informed consent shall be legalized in ac cordanc e with the
order stated by the Law. The donor has the right to change his (her) decision.
Chapter VI
Organization of Using the Organ with the Aim of Transplantation or Treatment
Article 23.
1. The hospitals are liable to inform the specialized institutions possessing a
relevant license about the patients who were diagnosed to have total, irreversible
cessation of the cerebral function and who in accordance with medical criteria
can be considered as potential donors.
Article 24.
Taking of the organ for transplantation the quality of post-trans plantation functioning of which
significantly depends on the duration of its storage shall be agreed with the Transplantation
Information Center.
Article 25.
The cooperation of the institutions, transplantation banks and other medical institutions
possessing a relevant license is regulat ed by the contracts concluded between them.
Chapter VII
Management of Organ Transplantation Proce sse s
Article 26.
In accordance with the requirements of the Legislatio n of Georgia the Ministry of Labor, Health
and Social P rotection coordinates and cont rols the activities of the physical and juridical persons
engaged in organ transplant ation.
Article 27.
The Ministry of Labor, Health and Social Protection shall:
a) Work out the standards for finding, taking, storing and testing of organs;
b) Work out the criteria for selection and testing of donors and recipients, define the form of
standard doc uments indicat ed in Article 5 of this Law;
c) Define the organ quality control standards, control the observance of organ taking,
transportation and storage rules, as well as organ validity and histological compatibility
determination;
d) Periodically check the compliance of t he activities of the institutions, transplantation
banks with the stated standards and perform quality control of the medical service
rendered by the above institutions in the sphere of transplant ation; in case of nec essity
suspend the action of license or annul it;
e) Ensure information exchange about donors and recipients between the institutions and
transplantation banks possessing relevant licenses as well as forward t he information
from hospitals to the above institutions;
f) Regulate international c ooperation in the sphere of organ t ransplantation. Joint ly wit h the
interested departments participate in development of normative acts for human organs
import -export;
g) Cooperates wit h the associations and professional unions interested in organ
transplantation issues.
Article 28.
The Transplantation Council shall be formed at the Ministry of Labor, Healt h and Social
Protection the provisions and composition of which shall be approved by the minister.
Article 29.
The Transplantation Information Center shall be formed at the Ministry of Labor. Health and
Social Protection. The Center shall be headed by the physician possessing the relevant license or
a biologist experienced in tissue typing.
Article 30.
The interested medical institution shall be immediately informed about every decision of
Trans plantation Information Center concerning the organ forwarding to the institution possessing
a relevant license; the decision is recorded in a writing and shall contain all data basing on which
this decision was made. The copy of this document shall be forwarded to the institution
possessing a relevant license and respectively to the transplantation bank.
Chapter VIII
Institutions Posse ssi ng a Relevant License
Article 31.
Any medical institution of organizational-and-legal form envisaged by the Legislation of G eorgia
which has the license to take and transplant the organs and/or the license to provide
organization-and-technic al information support of those processes can be qualified as the
institution possessing a relevant license.
Article 32.
The following are the institutions possessing a relevant license: transplantation hos pital or its
department possessing a relevant license, Trans plant ation Information Center, Transplantation
Bank transplantation laborat ory.
Article 33.
The institution possessing a relevant license shall:
a) Ensure performance of the license stipulat ed activities using adequate technologies;
b) In accordance with the state order participate in registration of possible donors and
possible recipients as well as in compilation of the lists of persons who declared their
refuse to donate organs;
c) Ensure information exchange between the medical institution following up the possible
recipient or physician in charge of the possible recipient and organ transplantation
management institution;
d) In accordance with the stated order produce medical documents with obligatory indication
of identification number (code) of the transplanted organ;
e) Ensure observance of 24 hour working regime.
Article 34.
Trans plantation Bank shall perform testing and selection of the deceased and/or alive donors,
ensure that only the organ identified by the license is taken, typed, transported and stored with
the aim of its subsequent transplantation.
Article 35.
Any independent medical institution or a constituent part of a medical institution envisaged by the
Legislation of Georgia can serve as the Trans plant ation Bank.
Article 36.
Trans plantation Bank is managed by the physician or biologist possessing a relevant license.
Article 37.
In case if the organ stored in the Transplantation Bank is qualified as invalid for transplantation
the Bank has the right to give it away for research and educational purposes. Notification about
this shall be sent to Transplantation Information Cent er.
Article 38.
The detailed data about donor testing, organ taking, typing, t rans port ation. proc essing. storage
performed by the Transplantation Bank are recorded in the documents stored in the Bank.
Chapter IX
International Cooperation in the Sphere of Human Organ Transplantation
Article 39.
Georgia participates in organ transplantation international practice.
Article 40.
1. Only those organs are allowed for import taking, processing and validity confirmation of
which were performed in compliance with the requirements of the respective count ry
laws, which shall be reflected in the accompanying documents;
2. The right t o export the organ t o Georgia is authorized to t he institution possessing a
relevant license;
3. The unimpeded delivery of the human organs to the territory of Georgia is performed
basing on special application provided by the institution possessing a relevant license
and documents accompanying the organ;
4. General surveillance on the usage of imported human organs is performed by the
Ministry of Labor, Healt h and Social Protection of Georgia.
Article 41.
Export of the human organs from Georgia is allowed only under the permission of the Ministry of
Labor, Health and Social Protection of Georgia via Transplantation Bank.
Chapter X
Ensuring Transplantation Safety
Article 42.
In accordance with the Legislation of Georgia the donor’s testing, selection and typing of the
organ to be transplanted is conducted in any laboratory of organization -and-legal form
possessing a relevant license.
Article 43.
Inspection of the activities of the specialized transplantation laboratory is performed in
accordance with order state by the Legislation of Georgia.
Article 44.
The detailed results of the studies carried out in the laboratory indicated in A rticle 43 of this Law,
identity of the researcher and the dat e of study shall be recorded in writing in accordance with the
stated order. The document shall be forwarded to the Transplantation Bank and Transplantation
Information Center.
Article 45.
The Ministry of Labor, Health and Social Protection shall define the necessity to place the organ
forwarded to the Transplant ation Bank under the quarantine and the term criteria for its keeping
under t he quarantine, as well as the criteria defining the dangerous infections ris k groups among
the donors in cases when these infections are not identified.
Article 46.
If the medical information provided in the doc uments accompanying the organ t o be transplanted
is not full or does not comply with the normative documents in effect the institution possessing a
relevant license is liable to immediately notify the Ministry of Labor, Health and Social P rotection
about this. The Ministry shall mak e a decision on returning of the organ to t he Transplantation
Bank or its destruction.
Article 47.
If there is a document ed doubt or proof that the organ is the source of distribution of dangerous
infection it shall be destroyed in accordance with the stated order.
Chapter XI
Information Exchange and Storage
Article 48.
Trans plantation Information Center shall encipher t he identity of the donor using identification
number known only to the Center. As a rule, only identification number shall be indicated in the
documents accompanying the organ. The Ministry of Labor, Health and Social Protection shall
assign the identification number known only to t he Ministry to the donor’s identity information
obtained from the institution possessing a relevant license. The documents accompanying the
organ shall cont ain comprehensive data about the donor.
Article 49.
Only the Transplantation Council has the right to disclose the identity of the donor if:
a) The usage of the organ to be transplanted endangers the health of the recipient or other
person;
b) The bodies of law and order demand such disclosure basing on the Court Resolution;
c) The Minister of Labor. Health and S ocial Prot ection demands such disclosure in
accordance with the stated order.
Article 50.
The personnel engaged in taking, t ransportation, storage, distribution of t he organs, as wel l as in
their transplantation and treatment is liable not to disclose the identity of the donor and/or that of
the possible donor as well as their medical data except for the cases envisaged by Article 49 of
this Law.
Article 51.
The term of storing of documents containing written conclusions confirming total and irreversible
cessation of cerebral function, information about the measures to be undertaken to take the organ
from the alive or deceas ed donors as envisaged by Articles 14-15 of this Law as well as the
documents on taking, testing and storing of organs from alive or deceased donors is 20 years; on
expiring of this term the documents shall be destroyed in accordance with the stated order within
maximum one year term.
Chapter XII
Organ Trading Prohibition
Article 52.
Human organ trading is prohibit ed.
Article 53.
The cost of measures to be undertaken t o transplant the organ such as its testing, taking,
conservation, transportation, storage, preparation for usage, protection of recipient and oth er
persons from infection shall be covered in accordance with order stated by the Legislation of
Georgia.
Article 54.
Trans plantation of the organ is prohibit ed if t he physician is aware that the organ was taken with
violation of the rules stated by this Law.
Chapter XIII
Other Prohibitions
Article 55.
1. Any pressure exerted to obtain the written consent on organ donation is prohibited.
2. Violation of the rules of taking and usage of organs, parts of t he organs and tissues
envis aged by this Law will serve as a cause of action in accordance with the order stated
by the Law.
Article 56.
Disclosure of the identity of the possible donor or donor t o the persons who are not directly
participating in taking of organ is prohibited except for the cases envisaged by the Law.
Chapter XIV
Conclusions and Transitional Provisions
Article 57.
1. Relat ed with coming of this Law in force the following normative acts shall be adopt ed
before June 1, 2000:
a) On introduction or respective changes and amendments into the Code of
Administrative Infringement of Law and Criminal Code;
b) The Decrees of the President of Georgia:
b.a) “On Approval of Human Cerebral Death and Irreversible Cessation of Heartbeat
Criteria”
b.b) “On Approval of Organs Import -Export Order”
c) The Resolutions of the Minister of Labor. Healt h and Social Protection:
c.a) “On Approval of the Standards for Finding, Taking, Storing and Transplantation
of Organs”;
c.b.) “On Approval of Criteria for Selection and Testing of Donors and Recipients”;
c.c) “On Approval of the Organs Quality Control Standards”;
c.d) “On Approval of Provisions of Trans plantation Council, Transplantation Bank.
Information Center”;
c.e) “On Approval of Crit eria Defining the Necessity of Placing the Organs Under the
Quarantine, the Term of their Keeping Under the Quarantine, and Dangerous
Infections Risk Groups among the Donors”;
c.f) “On the Order of Organ Destruction”.
d) Joint Resolution of the Minister of Labor. Health and Social Protection and
Minister of Justice “On the Order of Legalization of the Decision Conc erning
Organ Transplantation During the Lifetime or After Death”.
2. This Law shall come in force from June 1, 2000 .
SLOVENIA (2001)
In March, a new law on transplantation entered into force. The law is in accordance with the
provisions of the current version of the Draft Protocol on Organ Transplantation to the Oviedo
Convention. The law has made possible the founding of Slovenia-Transplant, a non-profit
organisation for international exchange of organs. An independent committee for ethical issues in
transplantation has also been set up. Transplantation medicine is well established in Slovenia,
and public attitude towards organ donation after death is rather favourable. Electronic health and
social security card, which is just being int roduced, optionally contains the holder's statement
about whether he or she wishes or does not wish to donat e organs after deat h. This information is
only accessible under special conditions in order to protect the holder from any pos sible misus e.
Recently, and in connection with the law, a public debate was opened on the concept of brain
death and on reliability of its diagnosis (although strict medical criteria have been established and
carefully observed for many years in Slovenia).
Law on removal and transplantation of human organs for the purpose of treatment. This bill
also is harmonised with the documents of the CDBI, including the Draft Protocol on
Trans plantation. It is now in final stage of the parliamentary proc edure.
SWITZERLAND (2001)
1. Organ transplants
The following provision was approved in the referendum of 7 February 1999 and incorporat ed
in the Federal Constitution (this provision will eventually be included in the fully revised
Federal Constitution of 18 April 199 9):
Art. 24decies
1. The Confederation shall enact provisions in the field of the transplantation of
organs, tissue and cells. In so doing, it shall ensure the prot ection of human
dignit y, the individual and health.
2. It shall ensure an equitable distribution of organs.
3. The donation of human organs, tissue and c ells shall be f ree of charge.
Trading in human organs is prohibited.
The corresponding federal law on transplantation is in preparation. It will also regulate
xenotransplantation.
In the meantime, the following principles are applicable to xenotrans plant ation:
Since 1 August 1996, when the federal order of 22 March 1996 on the blood control, blood
products and transplants was introduced, there has been partial regulation in the area of
transplantation medicine at federal level. The order regulates the protection of recipients from
infections as well as trading in transplants.
Article 18, paragraph 1 (a), of the federal order stipulates that:
Anyone who removes transplants from humans or animals to graft them on
humans or mark et them for this purpose shall be required to inform the federal
authority concerned.
Article 19 states that:
Anyone who engages in an activity of the k ind described in Article 18 shall be
required to ensure that the organ removed and its human or animal donor were
controlled for the presence of pathogenic agents or indications of the presence
thereof.
The draft of 3 June 1998 of the Federal Council (Executive) on the amendment of the federal
order on the blood cont rol, blood products and transplants reads as follows:
Article 18a (new): Transplants of animal origin
1. It is prohibited to graft organs, tissue or cells of animal origin on humans.
2. On an exceptional basis, organs, tissue or cells of animal origin may be grafted
on humans as part of a clinical experiment if the federal authority concerned so
authorises.
3. Cells or tissue of animal origin may be grafted on humans if, in the current
state of scientific and technical k nowledge, it can been established that they
present no risk of infection for the population and if the federal aut horit y
concerned so authorises. Authorisation shall be issued only if the therapeutic
utility of the treatment has been demonstrated.
The principle of a prohibition on xenotransplantation will be temporarily applicable for a period
of nearly three years. In connection wit h the preparation of a federal law on transplantation,
which is expected to enter into force in the year 2002 at the earliest, it will need to be
considered whet her this prohibition should be retained.
2. Xenotransplantation
In Switzerland, xenotransplantation is not prohibited, but in the future it will be subject to
authorisation. At its autumn 1999 session, the Parliament departed from the Federal Council's
bill (which proposed a general prohibition subject to possible exceptions), amended the
federal order on the supervision of blood, blood products and transplants and adopted the
following provisions:
Section 18a
1) The grafting of cells, tissue or organs of animal origin onto human beings shall require
the authorisation of the compet ent federal service.
2) Cells of tissue or organs of animal origin may be grafted onto human beings as part of
a clinical experiment if a risk of infection for the po pulation can be excluded with a high
probability and if it can be expected that the graft will be of therapeutic benefit.
3) Cells of tissue or organs of animal origin may be grafted onto human beings as part of a
standard treatment if, at the present state of scientific and technical k nowledge, a risk of
infection for the population can be excluded and if clinical experiments show that the graft is of
therapeutic benefit.
In actual fact, it can be considered that there is now a moratorium on xenot rans plantation.
The regulations on xenotransplantation provided for under the federal order on the supervision of
transplants are in effect pending the entry into force of a federal Act on transplantation, and until
the end of 2005 at the latest.
Other Topics Concerned: Biomedical Research, Reproductive Rights,
JAP AN (2000)
The Law on Organ Transplantation (LOT)
In Japan, The Law on Organ Transplantation(LOT) passed the Diet on June 17th in 1997 and
was put into forc e on October 16th in the same year.
It took seven years for the legislation of LOT since a task force had been established in the
government. In the task force (for the first two years ) and in the Diet, t he members discussed
several issues, such as whether the brain death could be regarded as the death of an individual
or not.
(1) Organs covered by the LOT
The LOT covers the heart, the lung, the liver, the kidney, the pancreases, the small
intestines and the eyeballs(corneas).
(2) The requirements for the removal of organs and for the diagnosis of brain death
To remove organs from dead body for transplantation, the LOT requires the following
conditions.
(a) the donor has expressed his/her will of donation for transplantation on paper before
his/her death.
(b) his/her bereaved next of kin does not reject the removal of organs, or he/she does
not have any bereaved next of kin.
In the LOT, "dead body" includes the body of the brain dead donor and it is legal to
remove organs from it.
And to diagnose as the brain death , the LOT also requires the following conditions.
(a) the donor has expressed his/her will of acceptance of the result of the diagnosis of
the brain death on paper besides the ex pression of his/h er will of donation.
(b) his/her next of kin does not reject the diagnosis of the brain death, or he/she does
not have any next of kin.
Therefore, to remove organs from the body of brain dead donor, donor's expression of
his/her will and his/her (bereaved) next of kin's cons ent regarding bot h donation and the
diagnosis of the brain death is required.
(3) Definitive diagnosis of the brain death
To maintain a national reliance on transplantation, the LOT shows a qualification of
physicians to diagnose the brain death and also of the method of diagnosis.
(4) Ot hers
The LOT prohibits the trade in organs for profit, and the foundation without permission of the
authority of organizations for organ procurement and distribution.
GREECE (1999)
1. Law N°2737/1999:Transplantations of human tissue s and organs and other
provi sions. Official journal of the Government of the Hellenic Democracy (A174/27
August 1999)
CHAPTER A : General provisions
Section 1
The removal of human tissues and organs with the purpose of tr ansplantation is carried out for
therapeutic purposes.
This law does not applies
a) to homologous transplantations
b) to removal and transplantation of testicles and ovaries
c) to blood trans fusion
d) to removal and use of ova and sperm
e) the implantation of embryos.
Section 2
The removal of tissues and organs for transplantation reasons is done wit hout any exchange. Any
transaction between the recipient, the donor and their families is forbidden.
Section3
Expenses are covered by the insurance organisation of the rec ipient.
Section 4
Transplantation units
Trans plantation may be carried out in specifically organised units of hospitals (public or non profit
private ones).
Section 5
Co-ordinators of transplantations
Co-ordonators of transplantations will offer their services for the advanc ement of transplantation.
Section 6
Tissue banks and National List of volunteer donors of bone marrow.
Section 7
Future recipients
National list of future recipients after certification of their suitability.
Distribution of grafts : a) t he organ is taken into consideration, b) it is based on criteria like blood
type, matching of tissues, emergency, waiting time, age, weight, locality.
Section 8
List and data
Section 9
Sensitive data
CHAPTER B : Live donors
Section 10
Conditions and procedure.
Removal of organs or tissues from a living pers on may be carried out solely for the therapeutic
benefit of a recipient where there is no suitable organ or tissue available from a deceased person,
there is no other alternative met hod of comparable effectiveness, and there is no serious risk for
the life or the health of the donor.
Removal of tissues and organs from a living person is allowed only when the transplantation
concerns the hus band or wife of the donor or a blood relative up t o the second degree. This does
not apply to bone marrow.
Removal is permitted only when the potential donor is an adult. Exceptionally removal of bone
marrow from a minor is allowed, if the transplantation concerns brothers or sisters and the
removal is necessary to save the life of the recipient, if there is no compatible donor available
who has the capacity to consent, and the authorisation of both parents has been given.
Removal of tissues and organs from a living person is permitted when this person has the ability
to give valid consent. This consent is given freely aft er information on t he aim, the nature, and
potential risks of the operation. There is a certain form for this consent.
Section 11
Compensation
In case of injury or death of the donor the re is a compensation by the state.
Chapter C : Organ and ti ssue removal from deceased persons
Section 12
Conditions and procedure
Organs or tissues shall be removed from the body of a deceas ed person only for a therapeutic
purpose, when that pers on has been certified dead.
The removal can be carried out if the potential donor had given his written consent. The removal
is not allowed if he had rejected it in writing.
In every general census of t he population, every adult is asked to declare in writing, in a specific
document if he consents on not to the removal of tissues or organs from his body in case of
death. If such a declaration has not been done municipalities and insurance organisations may
take care the gathering of these declaration.
If the potential donor had not expressed his consent or denial, the removal is carried out when the
husband or wife, adult children, parents, or brothers and sisters do not dissent.
Cons ent or dissent may always be freely withdrawn.
When the attending physician diagnoses death of the brain stem, and if the function of certain
organs is detained with technical means, he is obliged to write t he death certificate in
collaboration with an anesthesiologist and a neurologist or neurosurgeon. In the certification of
death a doctor who is a member of the transplantation team is not allowed to t ake part. The
attending physician must inform immediately the National transplantation Organisation and in
cooperation with it he inform the husband or wife or the relative on the death and the possibility of
organ donation.
Section 13
Anonymity is being respected
Section 14
Donation to a certain person is not allowed
Chapter D : National transplantation Organisation
Chapter E : Penal provisions
2. The commission of the Ministry of Health on Medically Assi sted Production has
completed its work and pres ented its report.
A new Commission has been appointed for t he preparation of a law on Medically Assisted
procreation, based on the report of the first Commission.
3. Ethi cs Committees
1992 National Council of Medical Ethics (law 2071/1992) Not functioning yet
1992 Hospital Ethics Committees (law 2071/1992) Not functioning yet in a large scale
1997 National Council of Medical Ethics was renamed
to national Bioethics and deontology Committee Not functioning yet
1997 Hellenic Committee on Bioethics (general secretariat
for research and technology of the Ministry of development) functioning
1998 The Greek Orthodox Bioethics Committee functioning
1998 National Committee on Human rights functioning
1998 National Committee on Bioethics (both Committees
answer directly to the prime minister functioning
2. Protection of the hospital patient
Laws 2071\1992, 2519\1997 and 2716\1999
Laws 2716\1999 concerning the psychiatric patient.
TURKEY (1999)
1. Organ and Tissue Transplantation
Trans plantation of organs and tissues is regulated in Turkey by the Law on removal,
preservation and implantation of organs and ti ssues, N° 2238 ( 29 May 1979) (as amended
by the Act N° 2594 of 21 January 1982).
The law N° 2238 is composed of four chapters: general provisions, requirements for removal of
organs and tissues from living persons, requirements for organs and tissue removal from
deceased persons and sanctions. [A report on organ transplantation in Turkey is available from
the Secretariat of Bioethics Section ].
2. Protection of persons in medical research under Turki sh law.
[A document concerning this issue is available from the Secretariat]
Medical research is subject to the regulations for Medical Deontology, Guide for Good Clinical
Practices (1995) and the Guide for Good Laboratory Practices (1995) issued by the Ministry
of Health. In the preparation of these guidelines, the Ministry has taken into account the
worldwide established rules in these fields. The principles of the revised Helsinki Declaration and
the guidelines for Good Clinical Practice in EU were adopted in many aspects of medical
research on human beings.
Regarding informed consent to medical research, the Act on Practice of Medicine and its
Branches, N° 1219 of 11 A pril 1928 applies mutatis mutantis. Moreover, the regulation of
Medical Deontology of 13 January 1960 is taken into account.
Medical int ervention on embryos is subject to the bylaw On treatm ent Methods A ssi sting
Procreation. With regard to informed consent, general rules apply mutatis mutandis.
Drug trials may be carried out under the bylaw On Pharmaceutical researches. In such
research, the Bylaw on Evaluation of Bioavailability and Bioequi valence of Pharm aceutical
Preparations is also taken int o account.
The mandatory rules of the Basic Law on Health services, N° 3359 requests informed consent
in drug trials.
3. The Act on Population, N° 2827 (24 May 1983), addresses the questions on sterilisation
and abortion. [The Secretariat has a document on this issue].
Other Topics Concerned: Biomedical Research
