Sex equity in organ donation and access to transplantation represents a key priority of the European Committee on Organ Transplantation of the Council of Europe (CD-P-TO). To increase our knowledge on sex-related differences in transplantation in the Council of Europe Member States, a specifically designed questionnaire was distributed to the CD-P-TO countries. Results confirm that, irrespective of the organ, males represent the majority of patients on the transplant waiting list. For all organs except for heart the time spent on the waiting list was shorter for men compared to women. Women represent the majority of living kidney donors (58%), whilst males are the major source of livers from living donation (54%). Across all organ types, men received 64% of deceased donor organs and 58% of living donor organs. We have found sex-related differences in transplantation activities conducted in the Council of Europe Member States. However, these may be the consequence of the higher incidence of some diseases in men, organ size mismatch, or the greater difficulty in finding immunologically compatible donors in women. At this stage, the CD-P-TO will continue its monitoring activity on this highly relevant topic and possibly extend its commitment beyond sex to include gender related aspects.

BACKGROUND:Solid organ transplantation has evolved globally as an established and life-saving treatment for patients with end-stage organ failure. METHODS:Since 2007, the Global Observatory on Donation and Transplantation (GODT), an initiative of the World Health Organization in collaboration with the Organización Nacional de Trasplantes (Spain), collects data and reports on the activity of World Health Organization member states in regard to solid organ donation, transplantation, and waitlisting. This ongoing effort provides insights into transplant activities in countries with different healthcare systems and practices, economic and cultural contexts, and local disease burdens. RESULTS:This annual report presents activities for the year 2024 and summarizes the developments from a global, regional, and country-specific perspective. This report includes information from 92 countries that submitted their data to the GODT by October 29, 2025. Descriptive statistics were applied to analyze and present key indicators. CONCLUSIONS:A record 173 727 solid organ transplants were performed worldwide in 2024, representing the highest number ever reported to the GODT. This corresponds to a 2% global increase compared with 2023, largely driven by a rise in deceased donations, particularly the expansion of donations after the circulatory determination of death, which accounted for 28% of all deceased donation activity in 2024 (total deceased donations: 47 180). Despite these achievements on a global scale, the data also indicate that major challenges persist, including a continued shortage of organs and pronounced geographical disparities in access to transplantation.

In view of the public consultation recently launched by the World Health Organization on Regulatory Convergence of Cell and Gene Therapy Products and the Proposal for a Regulation on substances of human origin (SoHO) repealing the European Union Directives on Blood and on Tissues and Cells, an opportunity arises to define an ethical and transparent framework of collaboration between industry and authorities responsible for SoHO-derived products, comprising medicines, medical devices, transfusion, and transplantation. The commodification of SoHO-derived medicinal products and medical devices entails important risks to the sustainability of healthcare systems and threatens the equitable access of patients to innovative therapies. It may also jeopardize the principle of altruistic donation of SoHO that is required for the treatment and survival of thousands of patients every year. This article puts forward several proposals aimed at reconciling the ethical principles of voluntary and unpaid SoHO donation and the noncommercialization of the human body with obtaining a profit that allows business activities, while ensuring high quality, safety, and efficacy standards of tissues and cells for clinical use.

Background Huntington’s disease (HD) is an autosomal dominant, hereditary, neurodegenerative disease presenting neurological, psychiatric, and cognitive impairment. Aims To study cognitive and neuropsychiatric differences between asymptomatic and symptomatic carriers of HD considering disease progression, and compare with healthy controls (HC). Methods We evaluated 89 HD carriers [37 asymptomatic, 24 symptomatic (<5 years of evolution), 28 symptomatic (>5 years evolution)] and 77 HC. Evaluated aspects were motor function (UHDRS), general cognitive status (MoCA) and cognition (visual cognition, verbal fluency, processing speed, and mental flexibility), and neuropsychiatric symptoms (anxiety, irritability, apathy, suicide, quality of life, depression and daily life activities). We performed one way ANOVA and Tukey’s test for post hoc analysis. Results Statistically significant differences were observed in motor function (F(3,147)=93.8; p<.001), general cognitive status (F(3,145)=27.7; p<.001) and visual memory (F(3,138)=20.9; p<.001) between groups. Symptomatic HD patients (>5 years evolution) presented greater impairment in processing speed, visuospatial abilities, verbal fluency, mental flexibility, depression, apathy, quality of life, and daily life activities compared to patients with <5 years evolution and asymptomatic carriers. Conclusions Symptomatic and asymptomatic HD patients show worse motor, cognitive and neuropsychiatric symptoms according to disease progression. The symptomatic group with >5 years of evolution presented greater cognitive deterioration, more apathy and depressive symptoms, worse quality of life and less capacity for daily life activities compared with other groups. Results highlight worse cognitive performance by asymptomatic carriers than HC in visual memory.

Discrepancies in donation and transplantation by sex and gender have previously been reported. However, whether such differences are invariably the inevitable, unintended outcome of a legitimate process has yet to be determined. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) is the committee that actively promotes the development of ethical, quality and safety standards in the field of transplantation in Europe. Whilst the ultimate objective is to shed light on the processes underlying potential gender inequities in transplantation, our initial goal was to represent the distribution by sex among organ donors and recipients in the CD-P-TO Member States and observer countries. Our survey confirms previous evidence that, in most countries, men represent the prevalent source of deceased donors (63.3% in 64 countries: 60.7% and 71.9% for donation after brain and circulatory death, respectively). In contrast, women represent the leading source of organs recovered from living kidney and liver donors (61.1% and 51.2% in 55 and 32 countries, respectively). Across countries, most recovered organs are transplanted into men (65% in 57 countries). These observations may be explained, at least in part, by the higher burden of certain diseases in men, childbearing related immune sensitization in women, and donor-recipient size mismatch. Future research should establish whether gender-related socially-constructed roles and socioeconomic status may play a detrimental role reducing the access of women to transplantation.

Objective To prospectively evaluate nocturnal sleep problems and excessive daytime sleepiness (EDS) in Parkinson’s disease (PD) patients, and analyze the influence of motor symptoms, treatment, and sex differences on sleep problems in PD. Methods Sleep disturbances of 103 PD patients were assessed with Parkinson’s Disease Sleep Scale (PDSS) and the Epworth Sleepiness Scale (ESS). Student’s t-test for related samples, one-way ANOVA with Tukey’s HSD post hoc test were used to assess group differences. Bivariate correlations and mixed-effects linear regression models were used to analyze the association between clinical aspects and sleep disturbances over time. Results At baseline, 48.5% of PD patients presented nocturnal problems and 40% of patients presented EDS. The PDSS and ESS total score slightly improve over time. Nocturnal problems were associated with age and motor impartment, explaining the 51% of the variance of the PDSS model. Males presented less nocturnal disturbances and more EDS than females. Higher motor impairment and combined treatment (L-dopa and agonist) were related to more EDS, while disease duration and L-dopa in monotherapy were related to lower scores, explaining the 59% of the model. Conclusions Sleep disturbances changed over time and age, diseases duration, motor impairment, treatment and sex were associated with nocturnal sleep problems and EDS. Agonist treatment alone or in combination with L-dopa might predict worse daytime sleepiness, while L-dopa in monotherapy is related to lower EDS, which significantly affects the quality of life of PD patients.

AimThe present study aimed both to gain knowledge on the distinctive clinical characteristics of older adults with coronavirus disease 2019 (COVID‐19), in comparison with those of younger patients, and to identify risk factors for mortality.MethodsA retrospective observational study was carried out of patients consecutively admitted to Doctor Peset University Hospital, Valencia (Spain) for COVID‐19 from 11 March to 28 April 2020. Every case was diagnosed by reverse transcription polymerase chain reaction or by serology test to detect antibodies. Demographic details, clinical characteristics, laboratory findings on admission and complications of each case were collected from electronic medical records.ResultsThe dataset comprised 340 patients. Of them, 152 (44.6%) were aged >70 years. Comorbidities were more common in the older groups. Confusion was more common in older adults, whereas typical symptoms of COVID‐19, such as fever, cough and myalgia, were less common. Oxygen saturation ≤93% on room air, neutrophilia, D‐dimer >0.5 μg/mL, creatinine >1.5 mg/dL, lactate dehydrogenase ≥250 U/L and elevation of creatine kinase were higher in the older adult groups.Complications during hospitalization, such as acute respiratory distress syndrome (53.3% vs 33.2%, P < 0.001), acute kidney injury (11.8% vs 5.3%; P = 0.030) and mortality (28.9% vs 6.5%; P < 0.001) were more common in patients aged >70 years. Oxygen saturation ≤93% on room air on admission was a predictor of mortality (odds ratio 11.65, 95% confidence interval 3.26–41.66, P < 0.001) in patients aged >70 years.ConclusionsOlder adults with COVID‐19 have more atypical presentation, more complications and higher mortality. Oxygen saturation ≤93% on room air on admission is a predictive factor of death. Geriatr Gerontol Int 2021; 21: 60–65.

Background HD is an autosomal dominant, hereditary, and neurodegenerative disease that presents neurological, psychiatric, and cognitive impairment, with visual cognition being one of the affected areas. Aims This study aims to analyze the visual cognition profile of asymptomatic and symptomatic carriers of Huntington’s disease (HD), compared with healthy controls (HC), and to evaluate the differences between asymptomatic and symptomatic patients with different years of progression of HD. Methods We evaluated 99 participants, 51 HD carriers [17 asymptomatic, 13 symptomatic ( < 5 years of evolution), 21 symptomatic ( > 5 years of evolution)] and 48 HC matched by sex and educational level. Motor function was rated with UHDRS scale, the general cognitive status was assessed with MoCA test, and a comprehensive battery of visual cognitive instruments was used. The following visual cognitive domains were assessed: visual memory, visuospatial skills and visuoconstructive abilities. One- way ANOVA and Tukey’s test for post hoc analysis were performed to analyze and compare the cognitive performance between the four groups. Results Statistically significant differences were found in the motor function (F(3.1)=14.129; p < .001) and in the general cognitive status (F(6.1)=9.63; p < .001) between groups. Specifically, we found significant differences in visual memory and visuospatial and visuoconstructive abilities between asymptomatic and both symptomatic subgroups of HD patients (p=.058), and also between the two groups of symptomatic patients with different years of evolution of HD (p=.014). Conclusions Findings suggest that both symptomatic and asymptomatic HD patients present an increased visual cognitive impairment compared to HC. This impairment worsens with HD progression.

The access of non-resident patients to the deceased donor waiting list (DDWL) poses different challenges. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) has studied this phenomenon in the European setting. A questionnaire was circulated among the Council of Europe member states to inquire about the criteria applied for non-residents to access their DDWL. Information was compiled from 28 countries. Less than 1% of recipients of deceased donor organs were non-residents. Two countries never allow non-residents to access the DDWL, four allow access without restrictions and 22 only under specific conditions. Of those, most give access to non-resident patients already in their jurisdictions who are in a situation of vulnerability (urgent life-threatening conditions). In addition, patients may be given access: (i) after assessment by a specific committee (four countries); (ii) within the framework of official cooperation agreements (15 countries); and (iii) after patients have officially lived in the country for a minimum length of time (eight countries). The ethical and legal implications of these policies are discussed. Countries should collect accurate information about residency status of waitlisted patients. Transparent criteria for the access of non-residents to DDWL should be clearly defined at national level.

Introduction The Global Observatory on Donation and Transplantation (GODT) is a collaborative effort of the World Health Organization and the Organización Nacional de Trasplantes of Spain. It is running since 2007 in response to the request of the World Health Assembly, in Resolutions WHA57.18 and 63.22, to collect global data on the practices, safety, quality, efficacy, epidemiology and ethical issues of allogeneic transplantation.This database is recognized as a tool for ensuring transparency, equity and monitoring national transplant systems. Objective To know the distribution of organ transplantation activities among the countries that report data to the GODT, and to assess the access to such practices around the world. Methods An ad hoc standard questionnaire is annually distributed to the identified health authorities and focal points contributing to the global database in each Member State (MS). The United Nations Population Fund report is used as the data source of population. Results Data of 111 MS have been analysed to describe the organ transplant activities in 2015(82.2% of the global population). 126,670 solid organs transplants were reported: 84,347 kidney (41.8% from living donors), 27,759 liver (21.0% from living donors), 7,023 heart, 5,046 lung, 2,299 pancreas and 196 small bowel transplants. Table 1 shows the absolute numbers and organ transplant rates (pmp) in the six WHO regions by applying the total regional population as the denominator.Kidney transplants were performed in 102 countries. Living kidney transplants were carried out in 98 and transplants from deceased donors in 76 countries. There were 16 countries performing only kidney living transplants (6.6% of the global population). 78 countries performed liver transplants during 2015. Liver transplants from living donors were carried out in 59 countries and from deceased donors in 66. There were 12 countries with living liver transplants alone and 19 countries performing only liver transplants from deceased. Heart and lung transplants were reported in 59 and 44 countries respectively. Of the total of lung transplants, 93.7% were from deceased donors. Only Japan, Brazil and Germany reported to perform lung transplants from living donors in 2015. Regarding pancreas transplants, they were carried out in 45 countries while only 15 countries reported small bowel transplants. Table 2 summarizes the distribution of population covered by the different types of organ transplants.Conclusion The human right to healthcare includes access to transplant therapy when needed. The international variation in solid organ transplantation activity reflects global inequities in access to transplantation but also highlights the potential of different organ donation and transplantation programmes to produce better outcomes. Following the Madrid Resolution requirements, “self-sufficiency” in organ donation and transplantation continues being a common global challenge.

Introduction The Newsletter Transplant of the Council of Europe publishes donation and transplantation international figures for organ, tissues and haematopoietic stem cell, and the documents produced by the committee of experts on the organizational aspects of co-operation in organ transplantation. It is edited annually since 1996 by the Spanish National Transplant Organization (ONT). We have taken into account the last 5 years (2012-2016) with the objective of describing the evolution of donation after circulatory death (DCD) figures and transplants performed from cardiac death donations. Materials and Methods Data Source: Information of the Newsletter is collected through a network of national focal points designated by the Ministries of Health of the participating countries, by means of a specifically designed questionnaire.Scope and Study Period: We selected the 22 countries that are nowadays performing DCDto perform a descriptive analysis and assess the development of their cardiac death donation and transplantation activities during the period 2012 to 2016. Neither Canada nor Russia report data for transplantation from DCD, so they have not been taken into account in that area. Results and Discussion In 2012 there were 2339 DCD vs 3557 in 2016, representing a 52% increase. By countries, the biggest increase has occurred in Italy, a 300% increase, going from 5 donors (0.08 per million population) to 20 (0.33). The country with the largest number of actual donors in absolute numbers is USA: 1684. The country with the highest rate of DCD pmp in 2016 is Spain (10.74). Since 2012, DCD is being performed in 8 more countries: Ireland, Israel, Lithuania, New Zeland, Norway, Poland, Portugal and Saudi Arabia.There has been a decrease in DCD in two countries: Russia and Latvia. Solid organ transplants from DCD have increased in this 5 year period. Kidney transplants have gone from 3179 (4.34 pmp) to 5176 (6.91). Increases over 100% were reported in Italy and Spain. There were decreases in Austria, Ireland, Latvia and Netherlands. Liver transplants from DCD are performed in 11 of the 20 countries for which data is available. In 2012 it was only performed in 9 countries. Liver transplants from DCD have increased from 534 (0.73 pmp) in 2012 to 970 (1.30) in 2016. Increases over 100% were observed in France and Spain. There were decreases in Australia and Austria.There were 138 lung transplants from DCD in 2012 and 266 in 2016. Lung transplants from DCD are only performed in 9 countries. There have not been variations in pancreas transplants during the study period. There were 71 transplants in 2012 and 72 in 2016. Pancreas transplants from DCD were performed in 3 countries during 2016. Conclusion DCD and transplants from DCD vary amongst countries reporting to the Newsletter Transplant. There is a steady increase in DCD donation and transplantation taking into consideration all the data available.

Introduction The Newsletter Transplant of the Council of Europe publishes donation and transplantation international figures for organ, tissues and haematopoietic stem cells, and the documents produced by a committee of experts on the organizational aspects of co-operation in organ transplantation. [1]In December 2008, the European Commission adopted a proposal for a Directive that defines quality and safety requirements for human organs intended for transplantation, and an action plan for improving co-operation between Member States in this field. The purpose of this research is to present the evolution of donation figures in the European Union (EU28) since the implementation of this action plan. Methods Data source: Information for the Newsletter is collected through a network of national focal points designated by the Ministries of Health of the participating countries, by means of a specifically designed questionnaire. Study period Data from the 28 EU member states has been analyzed to assess the evolution of actual donors during the period 2009‐2015. Definitions We have used the Newsletter of the Council of Europe’s definitions which are based on the “WHO Global Glossary of Terms and Definitions on Donation and Transplantation”. Statistical Methods Descriptive statistics (SPSS v.15.0) Results Cardiac death donation (DCD) has seen an important increase, representing a 7% in 2009 and a 12 % in 2015 (84 % increase). There have been changes in age distribution of donors. There has been a very significant increase in those above 60, a 35% (data available from 2010 onwards). This is a trend that is occurring in practically all EU28 countries. The variations in actual donations, however, are not the same for all EU28 countries. None the less there are countries in which donation has decreased.Conclusions - During the study period there has been an increase in actual donations in EU28, with variations between member states. - The increase of donors in absolute numbers is of 1230. - The contribution of U.K, France and Spain represents 72% of this increase (891 donors). - In countries with little activity in 2009 or that are small in population there has been an important increase in donation rate per million population during this period. - DCD implementation is limited to a few countries, but has seen an important increase in EU28. References 1. Newsletter Transplant Council of Europe years 2009‐2015. Available at: http://www.transplant-observatory.org/by-regions/(last accessed 24/04/2017).

Introduction The GODT is the most comprehensive source of worldwide data concerning activities of organ donation and transplantation. National statistics are annually provided by official sources and collected and managed by the Spanish ONT, under a collaborative work with WHO. Objective To describe the current international transplant activities during 2015. Methods The data for the GODT are annually provided by national focal points designated by the Ministries of Health of the responding countries, by means of an ad hoc questionnaire. The United Nations Population Fund report is used as the data source of population. Regional rates are calculated by applying the population of the responding countries as the denominator. The most recent available national figures were used to avoid the missing data, whenever those for 2015 were not provided. Descriptive statistics have been performed with SPSS v.15.0 software. Data of 111 Member States have been analysed to describe the organ transplant activities in 2015. Resutls The 102 countries which have any transplant procedure, out of 111 included in this study, cover the 80.95% of the global population. 126,670 solid organs (kidney, liver, heart, lung, pancreas and small bowel) were reported to be transplanted, which represents the 5.7% of increase over 2014. Kidneys and livers were transplanted in a large proportion (66% and 22% respectively). The percentage of transplants from living donors was 32.4% of the total organs transplanted and this type of procedure was more frequent in the Southeast Asia Region (94.4%), the Eastern Mediterranean Region (66.6%) and Africa (63%). There were 84,347 kidneys transplanted (41.8% from living donors), 27,759 liver transplants (21% from living donors), 7,023 heart transplants, 5,046 lung transplants (0.4% from living donors), 2,299 pancreas transplants and 196 small bowel transplants. There were 16 countries performing only kidney living transplants. Therefore, the 6.6% of the global population had access to this therapeutic option alone. According to the transplant rates (per million population (pmp)) the most active region in organ transplantation was America with 51.4 pmp followed by Europe (45.7). Conclusion The number of organs transplanted has increased over the previous year. There is a large variability in the number of transplantation practices between the six WHO regions as well as in the type of procedures (living vs deceased). AMR and EUR show higher activities and the transplants from deceased persons are more frequent than in SEAR, EMR or AFR where the living transplants are more prominent. The national focal points designated by the Ministries of Health of the respondent Member States. Reference: 1. The Global Observatory on Donation and Transplantation (GODT): http://www.transplant-observatory.org/.

Objective: To describe sudomotor function and its association to autonomic function and PD clinical variables in carriers of E46K mutation (E46K-SNCA), idiopathic Parkinson's disease (iPD), dementia with Lewy bodies (DLB) and healthy controls (HC). Background: Phosphorylated alpha-synuclein (Lewy bodies, LB and Lewy neurites), the pathological hallmark of PD, has been reported in small peripheral nerves. SUDOSCAN is a non-invasive device that has demonstrated its capacity to detect sudomotor dysfunction. However, we still don't know its association to cardiac MIBG Scintigraphy and clinical measures of PD. Methods: We evaluated cross-sectionally 48 sex/age matched participants: n=7 E46K-SNCA [4 motor parkinsonism, 1 with cough syncopes and 2 asymptomatic], n=19 iPD, n=3 DLB and n=19 HC. We obtained: electrochemical skin conductance in hands (HESC) and feet (FESC); myocardial/mediastinal uptake ratios (H/M) (all E46K-SNCA, n=12 iPD, n=2 DLB and n=1 HC); heart rate and blood pressure variability; SCOPA-AUT questionnaire and Ewing tests; PD manifestations (UPDRS, Hoehn and Yahr and cognition). Results: Symptomatic E46K-SNCA and DLB had lower HESC (E46K-SNCA: 62.4; DLB: 57.7; iPD: 69.7; HC: 71.2 us) (p ≤ 0.05) and FESC (E46K-SNCA: 70.4; DLB: 68.7; iPD: 74.4; HC: 74.5 us) (p above 0.05). Higher HESC asymmetry correlated with increased disease duration and L-Dopa levels. Lower HESC and FESC were associated to lower early MIBG H/M uptake and lower Valsalva ratio in patients (p<0.05), and this remained significant for FESC after removing the effect of disease duration and L-Dopa levels. Conclusions: Patients with PD had sudomotor dysfunction in hands and feet that was more severe in LB synucleinopathies (DLB and E46K-SNCA mutation). This sudomotor dysfunction was associated to myocardial sympathetic denervation and cardiovagal dysfunction even after removing the effect of disease duration and L-Dopa. These findings support the potential utility of Sudoscan as a biomarker of peripheral autonomic nervous system damage in PD with LB.

Abstract Rising incomes, the spread of personal insurance, lifestyle factors adding to the burden of illness, ageing populations, globalization and skills transfer within the medical community have increased worldwide demand for organ transplantation. The Global Observatory on Donation and Transplantation, which was built in response to World Health Assembly resolution WHA57.18, has conducted ongoing documentation of global transplantation activities since 2007. In this paper, we use the Global Observatory’s data to describe the current distribution of – and trends in – transplantation activities and to evaluate the role of health systems factors and macroeconomics in the diffusion of transplantation technology. We then consider the implications of our results for health policies relating to organ donation and transplantation. Of the World Health Organization’s Member States, most now engage in organ transplantation and more than a third performed deceased donor transplantation in 2011. In general, the Member States that engage in organ transplantation have greater access to physician services and greater total health spending per capita than the Member States where organ transplantation is not performed. The provision of deceased donor transplantation was closely associated with high levels of gross national income per capita. There are several ways in which governments can support the ethical development of organ donation and transplantation programmes. Specifically, they can ensure that appropriate legislation, regulation and oversight are in place, and monitor donation and transplantation activities, practices and outcomes. Moreover, they can allocate resources towards the training of specialist physicians, surgeons and transplant coordinators, and implement a professional donor-procurement network.

The Global Database on Donation and Transplantation represents the most comprehensive source to date of worldwide data concerning activities in organ donation and transplantation derived from official sources, as well as information on legal and organizational aspects. The objectives are to collect, analyse and disseminate this kind of information of the WHO Member States and to facilitate a network of focal persons in the field of transplantation. They are responsible for providing the legislative and organizational aspects and the annual activity practices through a specific questionnaire. 104 out of the 194 WHO Member States that cover the 90% of the global population contribute to this project.Although we know the numerous limitations and biases as a result of the different interpretations of the questions, based on cultural factors and language, there is no other similar approach to collect information on donation and transplantation practices all over the world. The knowledge of demand for transplantation, availability of deceased and living donor organs and the access to transplantation is essential to monitor global trends in transplantation needs and donor organ availability. Information regarding the existence of regulatory oversight is fundamental to ensure the ethical practice of organ donation and transplantation.