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Guide to Safety and Quality Assurance for Organs, Tissues and Cells

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Guide to Safety and Quality Assurance for Organs, Tissues and Cells Guide to safety and quality assurance for organs, tissues and cells 2nd edition Council of Europe Publishing French version: Guide sur la sécurité et l’assurance de qualité des organes, tissus et cellules ISBN 92-871-5517-8 For further information on the Council of Europe’s work in the field of organs, tissues and cells, please contact: Alina Tatarenko Administrative Officer Health Division Departement of Health and of the Partial Agreement in the Social and Public Health Field Directorate General III - Social Cohesion Council of Europe 67075 Strasbourg Cedex, France Tel: +33 3 88 41 28 47 Fax: +33 3 88 41 27 26 E-mail: [email protected] All rights reserved. No part of this publication may be reproduced or transmitted in anyform or by any means, electronic (CD-Rom, Internet, etc.) or mechanical, including photocopying, recording or any information storage or retrieval system, without prior permission in writing from the Publishing Division, Communication and Research Directorate. Cover: Rostyslav Hlukhovetsky Layout: DTP Unit, Council of Europe Edited by Council of Europe Publishing http://book.coe.int Council of Europe Publishing F-67075 Strasbourg Cedex ISBN 92-871-5518-6 © Council of Europe, September 2004 Printed in Belgium CONTENTS page Chapter 1 – Introduction ........................................................................................... 5 1.1 Introduction and scope ................................................................................... 5 1.2 Benefits of transplantation ............................................................................ 6 1.3 Risks of transplantation .................................................................................. 7 1.4 Ethical issues ....................................................................................................... 8 1.5 Quality management ....................................................................................... 9 1.6 Organisational issues ....................................................................................... 9 Chapter 2 – Quality management: principles for ensuring Chapter 2 – the quality of organs, tissues and cells .................................... 13 2.1 Introduction ......................................................................................................... 13 2.2 General principles ............................................................................................. 13 2.3 Examples of quality management systems ............................................. 13 2.4 Terminology ......................................................................................................... 14 2.5 Basic requirements ........................................................................................... 14 2.6 Quality management ....................................................................................... 15 Chapter 3 – Selection of donors ............................................................................ 21 3.1 General requirements ...................................................................................... 21 3.2 Deceased donors ................................................................................................ 21 3.3 Living donors ...................................................................................................... 34 3.4 Collection of surgical residues .................................................................... 38 3.5 Re-testing of living donors ............................................................................ 38 Chapter 4 – Organ procurement and preservation ...................................... 39 4.1 Deceased donors ................................................................................................ 39 4.2 Living donation .................................................................................................. 40 4.3 Organ preservation, packaging, transportation and traceability ... 41 Chapter 5 – Tissue and cell procurement ......................................................... 45 5.1 Procurement from deceased donors ......................................................... 45 5.2 Procurement from living donors ................................................................ 46 3 Guide to safety and quality assurance for organs, tissues and cells 5.3 Donor identification ......................................................................................... 46 5.4 Donor identification number ....................................................................... 46 5.5 Labelling and packaging ................................................................................ 46 5.6 Procurement documentation ....................................................................... 47 5.7 Storage and transportation to processing facility ................................ 48 5.8 Haematopoietic progenitor cells (hpc): specific issues ...................... 48 Chapter 6 – Tissue establishments ...................................................................... 51 6.1 General organisational requirements of a tissue establishment (TE) ..........................................................................................................................51 6.2 Facilities and equipment ................................................................................ 54 6.3 Tissue and cell processing, preservation and storage ........................ 56 6.4 Release of tissues or cells ............................................................................... 61 6.5 Distribution .......................................................................................................... 61 6.6 Traceability .......................................................................................................... 62 6.7 Transportation .................................................................................................... 62 6.8 Return into inventory ...................................................................................... 62 6.9 Exceptional release ........................................................................................... 62 6.10 Recipient adverse events and non-conformances ............................... 63 6.11 Hospital tissue and cell storage and distribution ................................ 63 Chapter 7 – Transplantation practices ............................................................... 65 7.1 Organisational issues ....................................................................................... 65 7.2 Pre-transplant period ....................................................................................... 65 7.3 Peri-transplant period ...................................................................................... 68 7.4 Post-transplant period ..................................................................................... 69 7.5 Use of organs, tissues and cells for purposes other than transplantation ......................................................................................... 70 Appendices ...................................................................................................................... 71 Appendix 1 – SP-SQA group participants ............................................................ 73 Appendix 2 – list of relevant standards/guidelines ......................................... 77 Appendix 3 – example of the evaluation of donor risk factors for Appendix 3 – transmissible diseases .................................................................... 79 Appendix 4 – definitions ............................................................................................ 81 Appendix 5 – Additional Protocol to the Convention on Human Rights Appendix 5 – and Biomedicine, on Transplantation of Organs and Tissues Appendix 5 – of Human Origin ............................................................................... 87 4 CHAPTER 1 – INTRODUCTION 1.1. Introduction and scope In 1999, the European Health Committee (CDSP) of the Council of Europe set up a working group to prepare guidance on the standards required and the quality assurance that should be achieved in services for the transplantation of human organs, tissues and cells in member states, resulting in this guide. The first edition was published in 2002. It was then decided to set up a Group of Specialists (SP-SQA) to update the guide every 2 years. The group worked on the second edition during 2003-04. In the meantime, the European Union adopted a Directive 2004/23/EC on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and dis- tribution of human tissues and cells. The Council of Europe and the European Commission will co-operate to ensure that the standards set under the direc- tive are compatible with the guide and that the same standards are applied throughout Europe. The purpose of this document is to provide guidance for all those involved in the transplantation of organs, tissues and cells to maximise their quality (and thereby the rate of success of transplants) and minimise the risks of this com- plex procedure. This guide includes safety and quality assurance standards for procurement, preservation, processing and distribution for organs, tissues and cells of human origin (allogeneic and autologous) used for transplantation purposes. The following is a non-exhaustive list of what is covered in the guide: – solid organs including kidney,
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