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Quality standards for human tissues and cells

Quality standards for human tissues and cells

Outline of the Community (European Union) legislation about Quality standards for human tissues and cells

Topics

These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Threats to health

Quality standards for human tissues and cells

Document or Iniciative

Directive 2004/23/EC of the European Parliament and of the Council of 31 March 2004 on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells [See amending act(s)].

Summary

Article 152 of the EC Treaty (henceforth Article 168 TFEU), requires the European Union to establish high quality and safety standards for the use of blood, organs and other substances of human origin.

In 1998, the European Group on Ethics in Sciences and New Technologies (EGE) confirmed the urgency of monitoring the conditions under which human cells and tissues circulate, the donation of which, anonymous and free, should remain basically a voluntary act. Moreover, the growing use of human tissues * and cells * in therapeutic treatment (reconstructive surgery, cancer and diabetes treatment) and the development of intra-Community trade in these substances make it necessary to define a minimum regulatory basis.

Tissues are groups of cells, which may be transplanted or implanted as viable cells, or otherwise preserved, fixed or altered. Originating from a live or dead donor *, they include: bone and musculo-skeletal elements (e.g. cartilage, tendons), cardiovascular tissues (e.g. arteries, veins, and heart valves), ocular tissue (e.g. cornea), nerve and brain cells, skin, foetal tissue, reproductive cells (e.g. semen, sperm, and ova) and stem cells.

SCOPE AND IMPLEMENTATION

This directive applies to the donation, procurement, testing, preservation, storage * and distribution * of human tissues and cells intended for human use. It also relates to manufactured products derived from human tissues and cells intended for human use. In the case of products made industrially from tissues and cells, the directive applies merely to donation, procurement and testing.

Blood and blood constituents, organs, tissues and cells used as an autologous graft * within the same surgical procedure and autologous cells for the manufacture of pharmaceuticals are excluded from the scope.

Member States must designate the competent authorities responsible for implementing the directive. They must keep the option of maintaining or introducing more stringent protective measures.

OBLIGATIONS ON MEMBER STATES’ AUTHORITIES

Supervision of human tissue and cell procurement

Member States must ensure that tissue and cell procurement and testing are carried out by persons with appropriate training and experience and that they take place in conditions approved by the competent authorities.

Accreditation, designation or authorisation of tissue establishments

All tissue establishments * must be accredited, designated or authorised by a competent authority, which may suspend or revoke such accreditation, designation or authorisation if, following inspections, it is shown that the establishment does not meet the requirements of the directive.

Inspection and control measures

The competent authorities must organise inspections and checks at tissue establishments at least every two years. The Member States, at the request of the Commission or another Member State, must provide information with information on the results of these inspections and checks.

Traceability

Member States must ensure traceability from the donor to the recipient and vice versa, of all tissues and cells procured, processed, stored or distributed on their territory. The traceability requirement also applies to all products and materials coming into contact with tissues and cells. To this end Member States shall ensure the implementation of a donor identification system which assigns a unique code to each donation and to each of the products associated with it. All tissues and cells must be identified with a label that contains information on the procedures for procurement and receipt, processing, storage and distribution.

The data necessary to ensure traceability must be kept for at least thirty years after clinical use.

Import/export of human tissues and cells

Member States must ensure that all imports and exports of human tissues and cells from and to third countries comply with the directive’s quality and safety requirements and are undertaken by accredited, designated and authorised tissue establishments so as to ensure the traceability of tissues and cells.

Register of tissue establishments and reporting obligations

The competent authorities must maintain a publicly accessible register of tissue establishments specifying the activities for which they have been accredited, designated or authorised. For their part, tissue establishments must keep a record of their activities and submit an annual report, which is also publicly accessible, to the competent authorities.

Notification of serious adverse events and reactions

Member States must provide for the creation of a system for the notification, registration and transmission of information on any incident linked to the procurement, testing, processing, storage, distribution and transplantation of tissues and cells.

DONOR SELECTION AND EVALUATION

Principles governing tissue and cell donation

Member States must encourage voluntary and unpaid donations of tissues and cells. However, donors may receive compensation strictly limited to making good the expenses and inconveniences related to the donation (e.g. travel expenses). No promotion and publicity activities are allowed in support of the donation of human tissues and cells with a view to offering or seeking financial gain or comparable advantage. The general rule is that Member States must endeavour to ensure that the procurement of tissues and cells is carried out on a non-profit basis.

Consent

The consent of donors, recipients or their next of kin is obligatory. They must receive information on the purpose and nature of the procurement, the associated risks, the analytical examinations, the recording and protection of donor details and medical confidentiality. In the case of a dead donor, all this information must be provided to the next of kin and all the necessary authorisations and consent must be obtained from the next of kin before any operation takes place.

Data confidentiality

Member States must take all necessary measures to ensure that all data collected and to which third parties have access are rendered anonymous. The recipient’s identity must never be divulged to the donor or his or her family, or vice versa. To this end, measures must be adopted to ensure data security and prevent unauthorised modifications to files and records.

Selection, evaluation and procurement

Donors must be evaluated and selected in accordance with strict standards, depending on the nature of the donor (dead or alive, specific case of children) and the type of operation.

QUALITY AND SAFETY OF TISSUES AND CELLS

Quality management

Each tissue centre must put in place a quality control system, which must include at least the following information: guidelines; operating procedures; training and reference manuals; donor records (to be kept for at least 30 years); information on the final destination of tissues or cells. These documents must be available for official inspections by agents of the competent authority.

Tissue and cell reception

Tissue and cell donations must be subjected to tests relating to specific requirements. The same applies in respect of selection, acceptance and packaging of tissues and cells.

Tissue and cell processing

Tissue establishments must include in their operating procedures all the processes that affect quality and safety. They must ensure that the equipment used, the working environment and process monitoring conditions comply with the requirements regarding the processing, storage and distribution of tissues and cells.

Tissue and cell storage conditions

Storage conditions must comply with specific requirements. Storage processes must be carried out under controlled conditions.

EXCHANGE OF INFORMATION, REPORTS AND PENALTIES

Member States must create a system for identifying human tissues and cells in order to ensure their traceability. With their collaboration, the Commission must devise a single European codification system in order to provide information on the main features and properties of the tissues and cells.

Member States must send the Commission, three years after the implementation date for this directive and every three years thereafter, a report on the activities undertaken, with reference to the provisions of this directive, and including an account of the inspection and monitoring measures taken.

Member States must lay down the rules on penalties applicable to infringements of the national provisions and notify those penalties to the Commission by the date when this directive enters into force at the latest.

Ethical considerations remain the responsibility of the Member States

In the course of the adoption process for the directive, many MEPs, concerned by the ethical aspects of the subject, advocated the inclusion of minimum requirements covering, in particular, a ban on human cloning and a guarantee that no abortions could take place with a view to obtaining foetal tissue. The outcome was that ethical considerations did not come under the scope of the directive and would therefore be left to the appreciation of the Member States. On the subject of cloning, the directive does not interfere with decisions made by Member States concerning the use or non-use of any specific type of human cells, including germ cells and embryonic stem cells.

Key terms used in the act
  • cells: individual human cells or a collection of human cells when not bound by any form of connective tissue;
  • tissue: all constituent parts of the human body formed by cells;
  • donor: every human source, whether living or deceased, of human cells or tissues;
  • storage: maintaining the product under appropriate controlled conditions until distribution;
  • distribution: transportation and delivery of tissues or cells intended for human applications;
  • tissue establishment: a tissue bank or a unit of a hospital or another body where activities of processing, preservation, storage or distribution of human tissues and cells are undertaken. It may also be responsible for procurement or testing of tissues and cells;
  • autologous use: cells or tissues removed from and applied in the same person.

References

Act Entry into force Deadline for transposition in the Member States Official Journal

Directive 2004/23/EC

7.4.2004

7.4.2006

OJ L 102 of 7.4.2004

Amending act(s) Entry into force Deadline for transposition in the Member States Official Journal

Regulation (EC) No 596/2009

7.8.2009

OJ L 188 of 18.7.2009

Related Acts

Implementing measures

Commission Decision 2010/453/EU of 3 August 2010 establishing guidelines concerning the conditions of inspections and control measures, and on the training and qualification of officials, in the field of human tissues and cells provided for in Directive 2004/23/EC of the European Parliament and of the Council [notified under document C(2010) 5278] Text with EEA relevance

This Decision establishes guidelines concerning the implementation of inspection and control measures in the field of human tissues and cells. It defines the responsibilities and the qualificatoin and training requirements of inspectors. However, they are not legally binding.

Commission Directive 2006/17/EC of 8 February 2006 implementing Directive 2004/23/EC of the European Parliament and of the Council as regards certain technical requirements for the donation, procurement and testing of human tissues and cells [Official Journal L 38 of 9.2.2006].
This implementing directive establishes specific technical requirements for each step in the human tissue and cell preparation process, in particular:

  • Requirements for the procurement of human tissues and cells;
  • Selection criteria for donors of tissues and cells;
  • Laboratory tests required for donors;
  • Tissue and/or cell donation and procurement procedures and reception at the tissue establishment;
  • Requirements for direct distribution to the recipient of specific tissues and cells.

Commission Directive 2006/86/EC of 24 October 2006 implementing Directive 2004/23/EC of the European Parliament and of the Council as regards traceability requirements, notification of serious adverse reactions and events and certain technical requirements for the coding, processing, preservation, storage and distribution of human tissues and cells (Text with EEA relevance)

This Directive applies to the coding, processing, preservation, storage and distribution of human tissues and cells, and products derived from human tissues and cells.

Implementation reports

Communication from the Commission of 6 January 2010 to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on the application of Directive 2004/23/EC on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells [COM(2009) 708 final – Not published in the Official Journal].

This Communication states that the implementation of Directive 2004/23/EC by Member States is satisfactory. Member States have now appointed their competent authorities. They have also put in place an accreditation, designation, authorisation and licensing system of tissue establishments, as well as systems for reporting, investigating, registering and transmitting information about serious adverse events and reactions, and testing requirements.
However, Member States must still put in place specific systems for authorising the tissue and cell preparation processes, as well as the process of accreditation, designation, authorisation and licensing of different establishments. They must also improve the inspection and monitoring of imports and exports of tissues and cells.

Organ donation and transplantation in the European Union

Organ donation and transplantation in the European Union

Outline of the Community (European Union) legislation about Organ donation and transplantation in the European Union

Topics

These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Threats to health

Organ donation and transplantation in the European Union

Organ transplantation remains essential for the treatment of certain diseases. However, several factors must be taken into consideration where this therapeutic method is concerned: the risk of transmission of disease, the limited supply of organs and organ trafficking. This communication therefore aims to present the various potential options to ensure the quality and safety of organs, increase their availability and combat organ trafficking.

Document or Iniciative

Communication from the Commission to the Council and the European Parliament of 30 May 2007 entitled “Organ donation and transplantation: Policy actions at EU level” [COM(2007) 275 final – Not published in the Official Journal].

Summary

During the past decades, organ transplantation has increased and become widespread. It is a form of treatment that is indispensable for certain diseases, and the results in terms of life years gained and improvement in quality of life are often positive.

Nonetheless, organ donation and transplantation are sensitive topics, dealt with differently throughout the EU in accordance with the cultural values and legal, administrative and organisational issues of each Member State.

Moreover, these topics present three major obstacles that the Commission intends to deal with. These are the risk of transmission of disease, the limited supply of organs and organ trafficking.

The Commission therefore plans measures to improve the quality and safety of organs, increase their availability in the EU and combat organ trafficking.

Improving quality and safety

HIV, hepatitis B and C, bacteria, fungi, parasites and various types of cancer can be transmitted when an organ is transplanted. The transmission of disease by a donor organ can result in the death of the recipient.

It is therefore essential that measures be introduced into every stage of the transplant process in order to improve the quality and safety of organs. A risk-benefit analysis must be carried out so that the organs can be allocated to suitable recipients.

This entails defining the risks to which the recipient is exposed in view of his/her characteristics and the profile of the donor, and determining the consequences of not performing transplantation. Following this analysis, a rational decision will be taken concerning the transplantation.

There is also a need for effective transportation of organs to avoid their deterioration. While maintaining medical confidentiality, the organ container must be labelled and contain the necessary documentation.

It is important to ensure traceability from the donor to the recipient. Any transplantation system must also be able to highlight unexpected complications and detect serious or unexpected adverse events.

Given that an organ donor is often also a tissue donor, the quality and safety requirements for organs will be associated with the existing community system for tissues and cells.

It is essential to set up systems for the authorisation of establishments and programmes of organ donation based on common quality and safety criteria.

However, the legislation concerning quality and safety differs from one Member State to another. A high level of protection for patients must therefore be ensured throughout the EU.

Increasing the availability of organs

The Member States are facing a serious shortage of organ donors on the one hand and an increase in the demand for organs on the other.

Rates of donors differ from one Member State to another. These differences may stem from cultural, social and historical factors in each country, and the organisational characteristics of the donation system and certain aspects of their health service.

Furthermore, families are not always made aware of the possibility of making a donation, and many potential donors are lost because they are not registered as such. The establishment of an effective system making it possible to find people who can become donors after their death thus remains essential to increase the rate of donations. This system must ensure that the organs of people who wish to become donors will really be available.

Training and employing health professionals involved in organising the donation process and identifying people who could become donors after their death has resulted in an increase in organ donations in several Member States.

Another method of increasing the number of donors is to encourage donations from living donors. These have increased in recent years, particularly because the risk to donors is low and the results of the transplants have been positive.

Donors who are not ideal because of disease and a history of malignancy (“marginal donors”) can also be taken into consideration under certain circumstances.

Raising public awareness also has a role to play in increasing donations. Society still does not take a positive view of organ donations, and some families refuse to donate the organs of deceased relatives. However, messages can influence individuals’ decisions. Effective communication therefore needs to be established. The help of communication experts is important here, and the media and health professionals need to have a better knowledge of transplantation issues.

Another way of raising public awareness is the use of a European donor card stating whether the holder wishes to donate his/her organs or not.

Fighting organ trafficking

Criminal organisations have recognised the lucrative opportunity presented by the gap between the supply of and demand for organs. As a consequence, such organisations may induce poor people to sell their organs.

Several international and Community legal instruments condemn and outlaw organ trafficking, such as the European Charter on Fundamental Rights and the Oviedo Treaty on Human Rights and Biomedicine and its Additional Protocol on the Transplantation of Organs and Tissues of Human Origin.

The Commission makes frequent reference to these instruments.

Follow-up actions

The Commission aims to make transplantation systems more efficient and more accessible. It is therefore necessary to identify the most efficient systems at EU level, promote best practice and help countries with less-developed systems to improve these.

It will also encourage the Member States to work together on establishing efficient systems aimed at identifying individuals who can become donors after their death, promoting training for professionals, encouraging donations from living donors and evaluating the use of organs from “marginal donors”.

The Commission proposes two mechanisms for action: an action plan on strengthened cooperation between Member States and a legal instrument on quality and safety of organ donation and transplantation.

The action plan will enable countries to increase organ donations and to provide fair access to transplantation, as well as exchanging expertise to improve organisational aspects.

As far as the legal instrument is concerned, a European directive setting standards of quality and safety for organs could be adopted. This instrument could, among other things, include quality and safety standards for the authorisation of establishments and programmes of organ donation, ensure a complete characterisation of the organ and establish authorisation structures.

Related Acts

Proposal for a Directive of the European Parliament and of the Council on standards of quality and safety of human organs intended for transplantation [ – Not published in the Official Journal].

This Proposal for a Directive on standards of quality and safety of human organs intended for transplantation lays down rules aiming to ensure high standards of quality and safety for organs intended for transplantation into the human body.

It applies to the:

  • donation;
  • procurement;
  • testing;
  • characterisation;
  • preservation;
  • transport;
  • and transplantation of organs.

To achieve that objective, the Proposal plans to rely on national quality programmes which ensure the traceability of organs at each stage in the chain from donation to transplantation or disposal.

Member States shall ensure that procurement of organs takes place in specialised procurement organisations and facilities. All organs must be characterised before transplantation.

Member States shall also attend to the conditions of transport of organs, ensuring traceability from donor to recipient. Their responsibility shall also extend to the personnel and the systems for the reporting of serious adverse effects and reactions.

It is also reiterated that organ donation must be voluntary and unpaid. Member States must provide donors with all the information necessary while guaranteeing their right to anonymity.

Member States shall designate the relevant competent authorities. The latter shall be responsible in particular for controlling the procurement organisations or transplantation centres and for supervising the exchanges of organs with other countries.

Codecision procedure ()

Directive 2004/23/EC of the European Parliament and of the Council of 31 March 2004 on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells [Official Journal L 102, 07.04.2004].

Directive 2002/98/EC of the European Parliament and of the Council of 27 January 2003 setting standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components and amending Directive 2001/83/EC [Official Journal L 33, 08.02.2003].