Transplantation: WHO Reports 173,727 Organ Transplants in 2024—Yet They Meet Less Than 10% of Global Needs
KEY FACTS
- A record 173,727 solid organ transplants were performed worldwide in 2024, representing a 2% increase over 2023 and the highest number ever reported to WHO’s Global Observatory on Donation and Transplantation
- WHO data from 2022 shows more than 150,000 solid organ transplants are performed annually—yet this represents less than 10% of global needs, leaving millions on waiting lists
- In May 2024, the 77th World Health Assembly adopted Resolution WHA77.4 calling for a global strategy on donation and transplantation to be presented for adoption in 2026
- Donations after circulatory determination of death (DCD) accounted for 28% of all deceased donation activity in 2024, with 47,180 total deceased donations reported from 92 countries
- Between 2019 and 2020, the global rate of organ donation from deceased donors per million population decreased by 17.6%—a 33% drop in the Americas—worsening already severe organ shortages
When the 77th World Health Assembly convened in Geneva in May 2024, Spain spearheaded a resolution that would reshape global transplantation policy for the next decade. Resolution WHA77.4—adopted on May 29, 2024—calls for WHO to develop a comprehensive global strategy on donation and transplantation of human cells, tissues, and organs, to be presented to Member States for adoption in 2026. The resolution also directs WHO to examine establishing a World Donor Day to raise public awareness about altruistic donation.
“This has been a very important effort for a number of reasons,” said Dr. Beatriz Domínguez-Gil González, General Director of Spain’s National Transplant Organization and author of the resolution. The new resolution replaces one adopted in 2010 and addresses a troubling reality: transplantation has been losing traction in the global agenda despite serving as a life-saving treatment for patients with end-stage organ failure.
The urgency becomes clear in WHO’s data. The Global Observatory on Donation and Transplantation—a collaborative initiative between WHO and Spain’s Organización Nacional de Trasplantes launched in 2007—reported a record 173,727 solid organ transplants performed worldwide in 2024. But here’s the stark context: this record number represents less than 10% of actual global needs. Millions remain on waiting lists. Thousands die waiting. Many countries lack transplant programs entirely.
This article examines WHO’s data on global health efforts addressing organ transplantation, investigates why supply meets barely one-tenth of demand despite decades of medical progress, and asks whether WHO’s 2026 global strategy can bridge the gap between those who need organs and those willing to donate them—or whether fundamental barriers of infrastructure, culture, ethics, and economics will continue condemning millions to preventable deaths.
What Is Transplantation? — WHO’s Definition
According to WHO, transplantation involves replacing non-functional cells, tissues, or organs with healthy counterparts obtained from another individual through voluntary donation during their lifetime or after their death. The organization emphasizes that transplantation of human cells, tissues, or organs saves many lives and restores essential functions where no alternatives of comparable effectiveness exist.
WHO distinguishes several categories of transplantation:
Solid organ transplantation encompasses kidneys, livers, hearts, lungs, pancreases, and small bowels. The organization notes that organ transplantation is often the best if not the only treatment for acute and chronic organ failure. For most patients with end-stage organ failure, transplantation represents both the optimal therapeutic option and perhaps the only option for survival and quality of life.
Tissue transplantation includes corneas, skin, heart valves, bones, tendons, and blood vessels. WHO reports that tissue transplantation benefits include survival after severe burn trauma, recovery of movement, closure of chronic wounds, rehabilitation of heart function, and restoration of sight. Tissue transplants allow many recipients to return to economically productive lives and promote their independence.
Cell transplantation covers hematopoietic stem cells (bone marrow transplants), pancreatic islet cells, and other cellular therapies. The organization notes that cell transplantation represents an increasingly important therapeutic modality.
WHO’s framework identifies two donor types with distinct characteristics:
Deceased donation occurs after death determination either by neurological criteria (brain death—DBD) or circulatory criteria (cardiac death—DCD). WHO defines an actual deceased donor as a deceased person from whom at least one organ has been recovered for the purpose of organ transplantation. The organization reports that in 2024, 47,180 actual deceased donors were reported globally, with donations after circulatory death representing 28% of all deceased donation activity—a growing proportion as medical protocols expand.
Living donation involves a living person voluntarily donating an organ (typically a kidney, liver segment, or lung lobe) or tissue. WHO emphasizes that living donation depends on altruistic motivation and that living donors must be protected from harm and exploitation through appropriate medical evaluation, informed consent, and long-term follow-up care.
The organization’s Global Glossary on Donation and Transplantation provides standardized definitions essential for international data collection and comparison. Terms WHO defines include domino transplant (a procedure where an organ is removed from one transplant candidate and immediately transplanted into a second patient, with the first patient receiving a new organ from a deceased donor), transplant tourism (travel for transplantation involving organ trafficking and/or transplant commercialization), and organ trafficking (the recruitment, transport, transfer, harboring, or receipt of deceased or living persons for the purpose of removing organs for transplantation).
Global Burden — WHO’s Transplantation Data
The scale of transplantation activity globally shows both remarkable growth and devastating shortfalls. According to WHO’s Global Observatory on Donation and Transplantation 2024 report published in PMC, a record 173,727 solid organ transplants were performed worldwide in 2024, representing a 2% increase compared with 2023 and the highest number ever recorded since data collection began in 2007.
Breaking down transplantation by organ type reveals where activity concentrates. Kidney transplantation dominates, accounting for the largest proportion of procedures. Liver transplantation represents the second most common solid organ transplant. Heart, lung, pancreas, and small bowel transplantations occur in smaller but clinically critical numbers.
The growth trajectory since WHO began systematic monitoring shows significant expansion. WHO’s May 30, 2024 news release noted that data from 2022 showed more than 150,000 solid organ transplants performed worldwide annually—an increase of 52% compared with 2010. This represents substantial progress in absolute terms.
But the demand side tells a devastating story. WHO reports that current transplant activity meets less than 10% of global needs. The organization’s data from 92 countries submitting information to the Global Observatory reveals massive waiting lists in countries with established transplant programs—and no access whatsoever in countries lacking programs.
Deceased donation rates show profound geographic disparities. Spain leads globally with 48.9 donors per million population in 2024—a rate sustained for over three decades through the Organización Nacional de Trasplantes’s coordinated hospital network and professional training. The United States reported high absolute numbers with more than 27,700 kidney, 11,400 liver, 4,500 heart, and 3,300 lung transplants in 2024. European countries with mature systems show rates of 20-40 donors per million population.
In stark contrast, WHO data reveals that much of Africa, Asia, and Latin America maintain extremely low donation rates. Many low- and middle-income countries report fewer than 5 deceased donors per million population. Some countries report zero deceased donation activity. Factors WHO identifies include lack of public awareness campaigns, legal or religious barriers, insufficient hospital coordination programs, and absence of intensive care infrastructure necessary for identifying potential deceased donors.
Living donation patterns reveal different geographic concentrations. Research published in Transplantation journal analyzing the 2024 GODT data found that living donation accounted for 36.7% of all kidney transplants globally in 2024. In some countries where deceased donation programs remain underdeveloped, living donation represents the primary or only source of transplantable organs. WHO emphasizes concerns about living donor protection in settings lacking robust regulatory oversight.
Waiting list burdens documented by WHO show millions of patients registered for organ transplantation globally. For kidney transplantation, some countries report waiting times exceeding 5-7 years. The ratio between patients added to waiting lists and patients receiving transplants reveals the gap: ratios less than 1 indicate excess demand over supply, meaning waiting lists grow rather than shrink.
Deaths while waiting represent the ultimate measure of unmet need. WHO data from 2024 shows that 943 patients died while waiting for lung transplants (data from 42 countries). For pancreas transplants, 312 patients died waiting (20 countries). Small bowel transplants saw 23 waiting list deaths (9 countries). These figures represent only countries reporting data—the true global toll remains unknown as many countries lack formal waitlist registries.
The COVID-19 pandemic’s impact on transplantation revealed system fragility. Research WHO cites documented that between 2019 and 2020, the global rate of organ donation from deceased donors per million population decreased by 17.6%. In the Americas, the decline reached 33%—a catastrophic drop that worsened already severe organ shortages and resulted in thousands of additional deaths among waiting patients.
Age patterns in donors show shifting demographics. In 2024, almost half of all deceased donors were over 50 years old, forcing transplant systems to adapt criteria and refine assessments of organ viability. The organization notes this aging of donor populations reflects broader demographic trends but also creates technical challenges as organs from older donors may have reduced function or higher rates of complications.
Gender disparities emerge in WHO’s data. Among pancreas transplant recipients in 2024, 39.3% were female while 52.7% were male (35 of 39 countries with data). For small bowel transplants, 40.8% were female and 55.2% were male (17 of 20 countries with data). These gender imbalances warrant further investigation into whether they reflect disease prevalence patterns, access barriers, or referral biases.
Pediatric transplantation represents a specialized subset. WHO documented 58 pediatric pancreas transplants in 9 countries and 49 pediatric small bowel transplants in 8 countries during 2024. Children face particular challenges including organ size matching, immunological factors, and long-term outcomes spanning decades.
Causes, Transmission & Risk Factors — WHO’s Framework on Organ Failure
WHO’s framework identifies the underlying causes of organ failure that create need for transplantation rather than transmission pathways, as transplantation itself addresses consequences rather than infectious disease spread.
End-stage kidney disease represents the most common indication for solid organ transplantation globally. WHO documents that diabetes and hypertension serve as leading causes of chronic kidney disease progressing to end-stage renal failure requiring either dialysis or kidney transplantation. The organization notes that kidney transplantation offers superior survival and quality of life compared with dialysis while also proving more cost-effective long-term.
Liver failure requiring transplantation stems from multiple etiologies WHO identifies: viral hepatitis (particularly hepatitis B and C), alcohol-related liver disease, nonalcoholic fatty liver disease and steatohepatitis (increasingly prevalent with rising obesity rates), cirrhosis from various causes, acute liver failure from drug toxicity or viral infection, and primary liver cancers. The organization emphasizes that prevention of viral hepatitis through vaccination and treatment can reduce liver transplantation needs.
Heart failure necessitating transplantation arises from WHO-documented causes including coronary artery disease, cardiomyopathies (dilated, hypertrophic, restrictive), valvular heart disease, congenital heart disease, and myocarditis. The organization notes that heart transplantation serves as a last resort for patients with end-stage heart failure unresponsive to medical therapy and mechanical circulatory support.
Lung disease requiring transplantation includes conditions WHO identifies: chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis, pulmonary hypertension, and bronchiectasis. The organization reports that lung transplantation showed the proportionally greatest growth in 2024, exceeding 10% annual increase, though absolute numbers remain relatively small compared with other solid organs.
Pancreas failure addressed through transplantation stems primarily from type 1 diabetes mellitus. WHO notes that pancreas transplantation (often performed simultaneously with kidney transplantation in diabetic patients with diabetic nephropathy) can restore insulin independence and halt or reverse diabetes complications.
Risk factors WHO documents that increase organ failure risk and subsequent transplantation need include: smoking (major risk for cardiovascular disease, COPD, and certain cancers), excessive alcohol consumption (liver disease), obesity (nonalcoholic fatty liver disease, diabetes, cardiovascular disease), diabetes (kidney failure, requiring pancreas or combined kidney-pancreas transplant), hypertension (kidney failure, heart failure), viral hepatitis infections (liver failure), and genetic conditions (polycystic kidney disease, cystic fibrosis, certain cardiomyopathies).
The organization emphasizes that many conditions leading to organ failure are preventable through public health interventions: tobacco control, alcohol policy, healthy diet promotion, physical activity, viral hepatitis vaccination and treatment, and management of diabetes and hypertension. WHO notes that transplantation, while life-saving for those who need it, represents tertiary intervention addressing consequences of preventable diseases.
Signs, Symptoms or Health Impacts — WHO’s Clinical Framework
WHO identifies that signs and symptoms prompting consideration of transplantation vary by affected organ but generally reflect end-stage organ failure unresponsive to medical management.
Kidney failure manifestations WHO documents include: progressive fatigue and weakness from anemia, fluid retention causing swelling and shortness of breath, nausea, vomiting and loss of appetite from uremia, difficulty concentrating and confusion, and uncontrolled blood pressure despite medication. The organization notes that end-stage kidney disease requires either dialysis (a burdensome, time-intensive treatment with reduced quality of life) or kidney transplantation.
Liver failure symptoms WHO identifies encompass: jaundice (yellowing of skin and eyes), ascites (fluid accumulation in abdomen), hepatic encephalopathy (confusion, altered consciousness from toxin buildup), bleeding tendency from coagulation factor deficiency, severe itching, and muscle wasting. The organization emphasizes that acute liver failure represents a medical emergency requiring urgent liver transplantation for survival.
Heart failure signs WHO recognizes include: severe shortness of breath with minimal exertion or at rest, inability to perform daily activities, dependence on mechanical circulatory support devices, life-threatening arrhythmias despite optimal medical therapy, and cardiogenic shock. The organization notes that heart transplant evaluation typically occurs when medical therapy and device options have been exhausted.
Lung disease manifestations prompting transplant consideration WHO documents: severe breathlessness limiting all activities, oxygen dependence, recurrent life-threatening pulmonary infections, progressive decline despite maximal medical therapy, and respiratory failure. The organization reports that lung transplantation candidates often require continuous oxygen support and have severely limited exercise tolerance.
Quality of life impacts WHO identifies extend beyond physical symptoms: inability to work or perform household duties, dependence on family members for basic care, social isolation from activity restrictions, anxiety and depression associated with chronic illness, and reduced life expectancy. The organization emphasizes that successful transplantation can dramatically reverse these impacts, allowing recipients to return to productive, independent lives.
Post-transplant complications WHO acknowledges include: rejection (hyperacute, acute, or chronic) requiring immunosuppression adjustment, infection susceptibility from immunosuppressive medications, medication side effects (kidney damage from calcineurin inhibitors, diabetes from corticosteroids, bone disease, cardiovascular complications), malignancy (particularly skin cancers and lymphomas) related to long-term immunosuppression, and complications of surgical procedure. The organization notes that lifelong medical monitoring and medication adherence are essential for graft survival.
Psychosocial dimensions WHO recognizes affect both candidates and recipients: anxiety while waiting, guilt among living donor recipients, medication burden and lifestyle restrictions, financial stress from ongoing medical costs, and adjustment to post-transplant life. The organization advocates for comprehensive care addressing psychosocial needs alongside medical management.
Treatment or Health Response — WHO’s Transplantation Systems Framework
WHO reports that current approaches for transplantation require comprehensive systems encompassing legislation, regulation, healthcare infrastructure, professional training, and public awareness—not merely surgical procedures.
Legislative frameworks WHO emphasizes as foundational include: laws defining death determination criteria (neurological and circulatory), consent processes for deceased donation, living donor protection regulations, prohibition of organ trafficking and transplant commercialization, establishment of national transplant authorities providing oversight, and traceability systems ensuring safety and accountability. WHO Resolution WHA77.4 adopted in May 2024 calls for Member States to strengthen regulatory frameworks and integrate transplantation into healthcare systems.
Deceased donation programs WHO advocates require: hospital protocols for identifying potential donors, trained transplant coordinators embedded in intensive care units, family approach processes balancing compassion with donation request, organ recovery surgical teams, preservation and transport systems maintaining organ viability, and allocation systems distributing organs equitably. The organization notes that Spain’s model—with hospital transplant coordinators, professional training, and family involvement—has been adopted or adapted by many countries as an international reference.
Living donation protection measures WHO requires include: comprehensive medical and psychosocial evaluation ensuring donor suitability, informed consent processes free from coercion or financial inducement, independent donor advocate separate from transplant team, surgical expertise minimizing donor risk, long-term donor follow-up monitoring outcomes, and donor registries tracking safety. The organization emphasizes that living donors must be protected from exploitation and provided with proper follow-up care.
Immunosuppression protocols enable graft survival by preventing rejection. WHO acknowledges that patients require lifelong immunosuppressive medications with significant side effects and costs. The organization notes that medication access and affordability represent major barriers in low- and middle-income countries where patients may discontinue immunosuppression due to cost, resulting in graft loss.
Access gaps WHO identifies reveal severe global inequities:
Infrastructure deficits affect many countries. WHO reports that many nations haven’t established appropriate systems including specialized workforce, intensive care capacity for deceased donor management, laboratory infrastructure for tissue typing and crossmatching, or surgical expertise for complex organ recovery and implantation.
Financing barriers prevent transplantation scale-up. The organization notes that transplantation requires substantial upfront investment (donor evaluation, organ recovery, surgery, intensive care) followed by ongoing costs (immunosuppression, monitoring, treatment of complications). Countries lacking universal health coverage exclude transplantation from public financing, rendering it accessible only to wealthy individuals who can pay or seek care abroad.
Workforce shortages limit transplant capacity. WHO emphasizes needs for transplant surgeons, nephrologists, hepatologists, cardiologists, pulmonologists, transplant coordinators, specialized nurses, and support staff. Training programs for these professionals require years and significant resources.
Regional differences WHO documents show transplantation concentrated in high-income countries with comprehensive health systems. Europe and North America have mature, regulated transplant systems. In contrast, WHO data reveals extremely low transplant rates throughout Africa, parts of Asia, and Latin America. Some countries perform no transplants whatsoever.
The organization advocates for integration of transplantation into universal health coverage, ensuring that patients with end-stage organ failure have access to this life-saving treatment regardless of ability to pay. WHO notes that cost-effectiveness analyses show kidney transplantation saves money compared with long-term dialysis, yet many countries continue paying for dialysis while not funding transplantation—an economically irrational but politically common choice.
Prevention & WHO Strategies — Public Health Policy Framework
WHO’s prevention framework for reducing transplantation needs focuses on addressing underlying causes of organ failure through public health interventions rather than on preventing transplantation itself, which serves as therapeutic response to organ failure.
Primary prevention strategies WHO advocates target modifiable risk factors: tobacco control policies reducing smoking-related cardiovascular disease, COPD, and certain cancers; alcohol policies preventing alcohol-related liver disease; obesity prevention and healthy diet promotion addressing nonalcoholic fatty liver disease and diabetes; physical activity promotion reducing cardiovascular disease risk; viral hepatitis B and C vaccination, screening, and treatment preventing liver failure; and diabetes and hypertension management preventing progression to kidney failure.
The organization emphasizes that expanding transplantation capacity while simultaneously implementing prevention strategies represents a dual approach: prevention reduces future organ failure burden, while transplantation addresses current cases where prevention wasn’t implemented or was unsuccessful.
WHO’s Guiding Principles on Human Cell, Tissue and Organ Transplantation—adopted by the World Health Assembly in 2010 and reaffirmed in Resolution WHA77.4—establish global ethical standards:
Principle 1: Cells, tissues, and organs may be removed from deceased persons’ bodies for transplantation if consent required by law is obtained and there is no reason to believe the deceased person objected. WHO emphasizes respecting cultural and religious beliefs about death and donation.
Principle 2: Physicians determining death should not be involved in organ removal or transplantation. The organization requires separation of death determination from transplant activities to prevent conflicts of interest.
Principle 3: Deceased and living donors should be free from coercion and commercial transactions. WHO prohibits organ trafficking, transplant commercialization, and transplant tourism involving organ trafficking.
Principle 4: No cells, tissues, or organs should be removed from the body of a living minor for transplantation except for narrow exceptions. The organization protects children from donation pressure.
Principle 5: Cells, tissues, and organs should be equitably allocated. WHO advocates for transparent allocation systems based on medical criteria rather than ability to pay or social status.
Principle 6: Promotion of altruistic donation requires transparency and accountability. The organization calls for national registries, traceability systems, and outcome reporting ensuring safety and quality.
WHO’s strategy for increasing organ availability includes:
Public awareness campaigns promoting deceased donation through opt-in consent systems or presumed consent with opt-out options. The organization notes that Spain’s success partly reflects sustained public education creating a culture of donation.
Professional education ensuring healthcare providers recognize potential donors, approach families appropriately, and manage donation processes skillfully. WHO emphasizes that transplant coordinator training represents a critical intervention.
System optimization maximizing conversion of potential donors to actual donors through improved hospital protocols, family support, and logistics. The organization reports that many potential donors are “lost” due to system failures rather than family refusal.
Expansion of donation after circulatory death (DCD) programs. WHO data shows DCD represented 28% of deceased donation in 2024, up from lower percentages in previous years. The organization notes that DCD protocols allow organ recovery from patients who don’t meet brain death criteria but whose death is imminent or where life support withdrawal is planned.
Living donation programs with robust donor protection. WHO advocates for living donation as a complement to deceased donation in kidney and liver transplantation, emphasizing that donor safety and autonomy must be paramount.
The organization’s framework recognizes that no vaccination exists to prevent organ failure, making prevention of underlying diseases—and treatment of organ failure through transplantation when prevention fails—the only available strategies.
WHO’s Global Efforts — Recent Resolutions and Editorial Analysis
WHO’s adoption of Resolution WHA77.4 on May 29, 2024, at the 77th World Health Assembly marks the most significant global transplantation policy development in 14 years. The resolution, initiated by Spain and approved by Member States, replaces the 2010 resolution and addresses transplantation’s declining priority in global health agendas.
“Transplantation has been losing traction in the global agenda,” Dr. Domínguez-Gil González acknowledged. The new resolution aims to reverse this by requesting WHO to develop a comprehensive global strategy on donation and transplantation for presentation to the World Health Assembly in 2026.
Key provisions WHO committed to include:
Development of a global strategy addressing disparities in donation and transplantation services across WHO regions and Member States, integrating ethical considerations and best practices, establishing monitoring frameworks for implementation, and supporting countries in building transplant systems.
Consideration of establishing a World Donor Day to raise public awareness and enhance understanding about altruistic donation of human cells, tissues, and organs. The organization will examine optimal timing, messaging, and coordination with existing awareness initiatives.
Support for Member States through technical guidance, capacity building, regulatory framework development, workforce training, and knowledge sharing. WHO will leverage collaborating centers and expert consultations.
In December 2024, WHO issued a call for experts to serve on the Expert Advisory Panel/Committee on Donation and Transplantation of cells, tissues, and organs (ECDT). According to WHO’s announcement, the committee will have up to 25 multidisciplinary members providing independent evaluation of scientific, technical, and socioeconomic aspects related to global transplantation development. The committee will advise on WHO norms, standards, technical guidelines, and strategic recommendations.
The Global Observatory on Donation and Transplantation continues as WHO’s primary data collection mechanism. The GODT—a collaborative effort between WHO and Spain’s ONT running since 2007—collects annual data on donation and transplantation practices from Member States. The 2024 report from 92 countries represents the most comprehensive global transplantation overview available.
But here’s what these achievements obscure: WHO faces fundamental barriers that policy resolutions alone cannot overcome.
First, the inequality problem appears intractable. High-income countries with comprehensive health systems perform 90% of transplants while containing perhaps 15% of patients with end-stage organ failure. Low- and middle-income countries—where organ failure burden concentrates due to untreated hepatitis, diabetes, and hypertension—perform minimal transplants or none. WHO can develop global strategies, but without massive resource transfers from wealthy to poor countries, this disparity will persist.
Second, the infrastructure gap requires billions in investment. Establishing a transplant program demands intensive care units for donor management, operating rooms for complex surgery, immunology laboratories for tissue typing, trained surgeons and physicians, transplant coordinators, specialized nurses, and supply chains for immunosuppressive medications. WHO has neither funding nor authority to build this infrastructure. The organization can provide guidance, but countries must finance implementation.
Third, the cultural and religious dimensions resist technical solutions. Some religious traditions prohibit organ donation. Some cultures view body integrity after death as inviolable. Some populations distrust medical institutions due to historical exploitation. WHO can promote “awareness,” but changing deeply held beliefs requires cultural negotiation beyond health sector interventions.
Fourth, the organ shortage shows no path to resolution. Even in Spain—the global leader with nearly 49 donors per million population—organs remain scarce relative to need. Expanding deceased donation has limits: only a small percentage of deaths occur in circumstances (brain death or circulatory death in intensive care with family consent and medically suitable organs) enabling donation. Living donation carries risks that appropriately limit its expansion. WHO can optimize systems, but fundamental biology limits organ supply.
Fifth, the ethical tensions create impossible dilemmas. Presumed consent (people are donors unless they opt out) increases donation rates but raises autonomy concerns. Financial incentives for living donors might expand supply but commodify human bodies and exploit the poor. Xenotransplantation (animal organs in humans) offers potential but faces technical hurdles, infection risks, and ethical objections. WHO advocates for altruistic donation and informed consent, but these principles inherently limit supply.
Sixth, the trafficking problem defies enforcement. WHO prohibits organ trafficking, transplant tourism, and transplant commercialization. But desperate patients travel to countries with lax regulations. Impoverished people in unregulated settings sell kidneys. Underground networks coordinate illegal transplants. WHO lacks enforcement power. The organization can advocate for national legislation and international cooperation, but criminal enterprises operate in regulatory gaps.
What should WHO do differently? Several opportunities exist for more aggressive action:
First, establish a global transplant fund providing grants to low- and middle-income countries for building transplant infrastructure. Pooled financing from wealthy countries could support hospital upgrades, equipment purchases, training programs, and medication subsidies. WHO currently facilitates technical assistance but doesn’t mobilize substantial financial resources.
Second, create tiered implementation standards recognizing different country capacities. Not every country needs cutting-edge lung transplant programs. But every country with dialysis capability should offer kidney transplantation—technically simpler and cost-effective. WHO could develop progressive implementation pathways: start with deceased donor kidney programs, add living donor protocols, expand to liver, then consider thoracic organs as capacity permits.
Third, invest heavily in prevention of organ failure. WHO’s resolution mentions transplantation’s role in reducing NCD mortality but doesn’t emphasize prevention. The organization should aggressively promote interventions reducing liver failure (viral hepatitis elimination, alcohol policy), kidney failure (diabetes and hypertension control), and lung failure (tobacco control). Every case prevented saves a transplant.
Fourth, support innovations potentially expanding organ supply. WHO should facilitate research on xenotransplantation, bioengineered organs, and mechanical circulatory support devices. While these technologies aren’t ready for widespread use, coordinated research might accelerate development. The organization could convene researchers, fund trials, and develop regulatory frameworks for novel therapies.
Fifth, address living donor protection through binding international standards. WHO’s Guiding Principles provide ethical framework but lack enforcement mechanisms. The organization could develop international registry systems tracking living donor outcomes globally, creating transparency that might deter exploitation. Countries performing living donor transplants could be required to submit outcome data as condition of WHO recognition.
Sixth, confront the deceased donation taboo more directly. WHO promotes “awareness” but avoids stating uncomfortable truths: deceased donation requires discussing death with families experiencing grief. Healthcare providers fear these conversations. Families decline donation due to cultural beliefs, religious concerns, or simple reluctance. WHO should sponsor research on effective family approach strategies, train healthcare providers in communication skills, and develop culturally adapted materials for diverse populations.
The fundamental question is whether WHO’s 2026 global strategy can overcome obstacles that have limited transplantation expansion for decades. High-income countries have had robust transplant programs for 30-40 years, yet still meet less than 50% of their own needs. Low-income countries have barely begun. Similar to challenges faced by groundbreaking medical researchers throughout historical efforts to combat disease, progress in transplantation requires not just scientific knowledge but also infrastructure, resources, cultural acceptance, and political will.
Transplantation saves lives—no question. A successful kidney transplant provides better survival, quality of life, and cost-effectiveness than dialysis. A liver transplant rescues patients who would otherwise die from acute liver failure. Heart and lung transplants grant additional years to people who would be dead within months. These aren’t marginal interventions—they’re dramatic, transformative therapies.
But WHO faces the hardest health policy question: how to expand access to expensive, complex, resource-intensive interventions in a world where billions lack basic healthcare. Should resources go toward building transplant programs or preventing the diseases that cause organ failure? The honest answer is both—but that requires funding levels WHO can’t command.
The 173,727 transplants performed in 2024 represent medical triumphs for those fortunate enough to receive them. The millions still waiting—and the hundreds of thousands who will die waiting—represent the boundaries of what current systems can deliver. Whether WHO’s 2026 strategy pushes those boundaries or merely documents existing limitations remains to be seen.
For patients with end-stage organ failure, the question isn’t abstract. It’s the difference between life and death. WHO has the moral authority, technical expertise, and global platform to advance transplantation. Whether the organization can translate policy resolutions into actual organs for actual patients will determine if 2024’s record 173,727 transplants represents a ceiling or a foundation for future expansion.
Frequently Asked Questions
According to WHO, deceased donation occurs after death determination by either neurological criteria (brain death) or circulatory criteria (cardiac death), with organs recovered for transplantation. Living donation involves a living person voluntarily donating an organ (typically kidney or liver segment) or tissue. WHO reports that in 2024, deceased donation accounted for 47,180 actual donors globally, while living donation provided 36.7% of kidney transplants. The organization emphasizes protecting living donors from exploitation.
WHO’s Global Observatory on Donation and Transplantation reports that a record 173,727 solid organ transplants were performed worldwide in 2024—the highest number ever recorded. This represents a 2% increase over 2023 and a 52% increase since 2010. However, WHO emphasizes this meets less than 10% of global needs, leaving millions on waiting lists. Data comes from 92 countries submitting reports to the WHO-Spain collaborative observatory.
WHO identifies multiple factors causing organ shortage: limited number of deaths occurring in circumstances enabling donation (intensive care settings with brain or cardiac death), family refusal or lack of consent, inadequate hospital infrastructure and trained coordinators identifying potential donors, cultural and religious barriers to donation, and absence of transplant programs in many countries. Living donation has limits due to donor risks. Current supply meets less than 10% of global transplantation needs.
WHO acknowledges that organ shortage can lead to illegal activities including trafficking in body parts, transplant tourism, and transplant commercialization. Resolution WHA77.4 adopted in May 2024 calls for measures to prevent and combat trafficking in people for organ removal and trafficking in human organs. The organization requires Member States to strengthen legislative frameworks and protect victims. WHO’s Guiding Principles prohibit commercial transactions in human cells, tissues, and organs.
According to WHO, research into xenotransplantation (using animal products for transplantation) and bioengineered materials is progressing and could help reduce dependence on human donations. However, these alternatives aren’t yet full replacements for human organ transplantation. WHO notes that even when xenotransplantation and bioengineered organs become available, high costs might limit access. For now, ensuring access to human cells, tissues, and organs for transplantation remains critical to addressing organ failure.
Sources
- World Health Organization. Transplantation. https://www.who.int/health-topics/transplantation
- Global Observatory on Donation and Transplantation. Organ Donation and Transplantation Worldwide: The Global Observatory on Donation and Transplantation 2024 Report. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12908642/
- World Health Organization. Seventy-seventh World Health Assembly – Daily update: 30 May 2024. https://www.who.int/news/item/30-05-2024-seventy-seventh-world-health-assembly—daily-update–30-may-2024
- World Health Organization. WHA77.4: Increasing availability, ethical access and oversight of transplantation of human cells, tissues and organs. June 1, 2024. https://apps.who.int/gb/ebwha/pdf_files/WHA77/A77_R4-en.pdf
- Global Observatory on Donation and Transplantation. 2024 Global Report. https://www.transplant-observatory.org/
- Pan American Health Organization. Groundbreaking new agreement on transplantation at 77th WHO. July 31, 2024. https://www.paho.org/en/news/31-7-2024-groundbreaking-new-agreement-transplantation-77th-who
DISCLAIMER
This article adapts publicly available information from WHO’s Transplantation page. This content is for informational and educational purposes only and does not constitute medical advice. ObserverVoice.com is a news and information platform — not a healthcare provider.
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