Explanatory Memorandum to COM(2002)319 - Setting standards of quality and safety for the donation, procurement, testing, processing, storage, and distribution of human tissues and cells - Main contents
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| dossier | COM(2002)319 - Setting standards of quality and safety for the donation, procurement, testing, processing, storage, and distribution of ... |
|---|---|
| source | COM(2002)319  |
| date | 19-06-2002 |
1. Each year in Europe, hundreds of thousands of patients undergo some form of therapeutic treatment based on the use of tissues and cells of human origin. Employment of these substances in the delivery of health care now goes beyond traditional transplants or implants into another human (allograft), to their incorporation into or combined with medical devices, and as the basis for services or products derived through biotechnology. While the therapeutic value of human allografts has been recognised for several decades, the increased number of implants as well as medical indications demands that requirements to ensure the quality and safety of human tissues and cells for clinical use be established in the European Union
2. Tissues are a functional group of cells, which may be transplanted or implanted as viable cells, or otherwise preserved, fixed, or altered. They include: bone and musculoskeletal elements (e.g. cartilage, tendons, fascias), cardiovascular tissues (e.g. arteries, veins, heart valves), ocular tissue (e.g. cornea, sclera), nerve cells, skin, brain cells, foetal tissue, reproductive cells (e.g. semen, sperm, ova) and stem cells (i.e. haematopoietic progenitor cells obtained from bone marrow, umbilical cord and peripheral circulation). As appropriate, these tissues and cells are used not only in reconstructive surgery such as corneal and hip replacement but also in the treatment of diseases such as cancer and diabetes, and increasingly in reproductive medicine. Advances in biotechnology have resulted in the production of tissue-derived products such as cultured allogeneic cells, engineered structural tissues, and constituent parts of medical devices. All these tissues or cells, which are frequently acquired through cross-border exchanges, come from donors who may be living or deceased.
3. Statistics related to the transplant of some of these human substances reflect their increasing importance to the health care delivery system. In the United States, the number of bone grafts increased 140% from 302,548 to 750,000 between 1992 and 1999. In Europe, the transplant of haematopoietic progenitors increased from less than 4,000 in 1990 to 18,720 in 1999. In 1998, the replacement of heart valves with human allografts numbered 3,412. Today, cornea transplantation in Spain amounts to more than 60 transplants per million population and more than 70 in France.
4. In order to increase public confidence in the use of human tissues and cells for application in the human body, it is essential, therefore, that EU provisions should ensure their quality and safety. Article 152 of the Treaty has provided the European Community (EC) with an opportunity, as well as an obligation, to implement binding measures laying down high standards of quality and safety for the use of blood, organs, and substances of human origin.
5. Increased therapeutic use of substances of human origin and the recognition that they can transmit diseases have led to extensive discussion not only on the need for increased safety measures but also on the associated ethical issues. This latter aspect was the subject of considerable debate during deliberations on the European Commission's proposal for a Directive on in vitro diagnostic medical devices i. Opposition to the inclusion of human tissues, which are frequently an integral component of medical devices, in the Directive was based on lack of control, during procurement, of the tissues and cells used as starting material; lack of authorisation for and inspection of manufacturers or tissue banks; non-binding application of standards implied by the Directive without common compulsory specifications; and the existence of over 50 notified bodies in Europe expected to assess product conformity, without scientific level control. The Directive that was ultimately adopted i was restricted to substances of human origin rendered non-viable, with most human products remaining unregulated.
6. In 1998, the European Group on Ethics in Science and New Technologies to the European Commission (EGE) confirmed that there was the urgent need to regulate the conditions under which human tissues circulate within the European market i. Four aspects were stressed in their report:
- the ethical imperative to protect health. As no substance of human origin is free from the risk of disease transmission, tissues, in particular those intended for transplantation to third parties or for the preparation of pharmaceutical specialities, must undergo advance testing to provide maximum health guarantees in accordance with the state of the art'';
- the integrity of the human body. This should be ensured when procuring tissues from an individual, whether living or dead;
- the prior, informed, and free consent of the person concerned. Before procurement of human tissues, as a principle the donor's consent must have been given on the basis of information provided in as clear and precise lay terms as possible; and
- The protection of identity. This requires that, in the interests of anonymity, any disclosure of information that could identify either the donor or recipient must be prohibited. In general, the donor should not know the identity of the recipient, nor vice versa - a requirement to prevent possible discrimination.
7. The EGE also noted that anonymous and free tissue donation basically remains a voluntary act of solidarity. People in each Member State should be encouraged to donate tissues in this spirit, thereby promoting shared aims and increasing the availability of substances of human origin in Europe. The EGE also discussed: the role and responsibilities of tissue banks and their profit or non-profit character; equitable access to the therapeutic opportunities afforded by the use of human tissues; and the need for tissue imports from third countries to be subject to at least equivalent ethical and health requirements. This proposal for a Directive reflects the recommendations put forth by the EGE.
8. While most Member States have adopted legislation to control the ethical aspects of donor protection (mainly in the area of organ transplantation), many have yet to agree upon rules covering quality, safety or the use of tissues and cells. An informal survey on existing regulations in the Member States carried out in 2000 i confirmed that considerable discrepancies exist in the coverage with only those aspects related to donor protection addressed to date by nearly all of them. Specific rules for the authorisation for and inspection of tissue procurement and banking activities are lacking in the majority, as are regulations for determining donor suitability and the importation of human substances. The percentages of Member States that have regulations in place covering different topics are illustrated in Tables 1 to 3.
9. During a meeting convened under the Portuguese Presidency in Porto in June 2000, experts in the areas of tissues and cells analysed the regulatory situation in Europe and concluded that there is an urgent need for an EC Directive on the safety and quality of these human substances. Subsequently, experts and official representatives of the Member States arrived at a similar conclusion at a Conference co-organised by the European Commission and the Spanish Presidency in Malaga in February 2002. They supported the idea of developing an EC Directive setting high standards of safety and quality for the procurement, testing, processing, storage, and distribution of human tissues and cells in order to ensure a high level of human health protection in the European Union. They also provided specific orientations for the development of such an initiative, which received a general welcome in an EU Ministerial Seminar that immediately followed the Malaga Conference.
Contents
- Scope and Objectives
- Processing, preservation, storage, and distribution of tissues and cells to be used for human transplantation
- Obligation of Member States authorities
- Donor suitability and evaluation: quality, safety, and ethical concerns
- Tissue banks
- 38. EUROPEAN UNION PROVISIONS OF RELEVANCE TO TISSUES AND CELLS
- 1. Voluntary and non-remunerated donations
- TABLE 2
- TABLE 3
- JUSTIFICATION
- B. LEGAL BASIS
- C. SUBSIDIARITY AND PROPORTIONALITY
- D. LEGISLATIVE AND ADMINISTRATIVE SIMPLIFICATION
- E. CONSISTENCY WITH OTHER COMMUNITY POLICIES
- F. OUTSIDE CONSULTATION
- PRESENTATION
10. For the first three steps of their use (donation, procurement, and testing), this proposal for a Directive covers all tissues and cells of human origin for application to the human body, except blood and blood products, tissues and cells used as an autologous graft within the same surgical procedure and organs, but including starting materials for tissue and cell derived manufactured products. However, autologous cells used for medicinal products are not covered by this Directive. Tissues and cells used for research purposes would be covered when administered to the human body, but not when used for research in vitro or in animal models. The further steps of their use (processing, preservation, storage, and distribution) are covered if the tissues and cells are intended for transplantation.
Donation, procurement, and testing of all human tissues and cells for application to the human body.
11. This proposal for a Directive on human tissues and cells aims to cover all human cells and tissues, which are used for application to the human body, during the first phases of the process - donation, procurement and testing - in order to ensure their quality and safety.
12. The proposal, however, excludes blood and blood products (other than blood precursors), human organs, as well as organs, tissues, or cells of animal origin. Blood and blood products currently are regulated by Directive 2001/83/EC i, Directive 2000/70/EC i and Council Recommendation 98/463/EC i, and a new directive based on public health principles is currently under discussion in Council and the European Parliament i.
13. The transplantation of human organs requires a different policy approach due to their specific nature and the severe shortages that result in many patients going untreated. The Commission will address this subject shortly by inviting national and international organisations involved in organ procurement for an exchange of information on the relevant issues.
14. Organs, tissues, and cells of animal origin for human therapy are still in the research phase, but nevertheless pose different regulatory problems that will need to be addressed in due course.
15. Tissues and cells used as an autologous graft (tissues removed and transplanted back to the same person), within the same surgical procedure and without being subjected to any banking process, are also excluded from this proposal. The quality and safety considerations associated with this process are completely different.
16. Autologous cells used for medicinal products require a completely different regulatory approach and therefore are completely excluded from this Directive.
17. This Directive does not intend to cover research using human tissues and cells, such as when used for purposes other than application to the human body, i.e. in vitro research or in animal models. Only those cells and tissues that in clinical trials are applied to the human body should comply with the quality and safety standards laid down in this Directive.
18. All other types of tissues and cells are covered. Some, however, in particular germ cells, foetal cells/tissues and embryonic stem cells, pose particular ethical concerns. To date, there is no consensus among Member States upon which basic harmonised decisions at EU level can be taken with regards to their use or prohibition. If, however, a particular application of these cells is accepted in a Member State, the relevant provisions of this Directive will apply.
Processing, preservation, storage, and distribution of tissues and cells to be used for human transplantation
19. When the tissues and cells are to be used for human transplantation, this proposal for a Directive applies to the processing, preservation, storage, and distribution phases. Transplantation aims to recover a lost tissue or cell function by transferring to the human body equivalent tissues or cells. If their preparation includes steps that influence growth or differentiation of these cells, additional safety measures might need to be considered in the future.
20. The proposal excludes these phases of the process, however, when the tissues or cells are to be used for other purposes such anti-tumoral vaccines or therapies where the objective is not to recover a function by transplanting equivalent cells or tissues. These new therapeutic approaches require different, and very specific, processing standards, which cannot be established now since the associated risks are still under investigation. Furthermore in those cases they will fall under the legislation covering medicinal products or medical devices.
21. The Scientific Committee on Medicinal Products and Medical Devices (SCMPMD) concluded i that the area of tissue engineering is not yet sufficiently developed, and clear boundaries cannot be drawn between it and other allied areas. Oversight for adequate control of the introduction and monitoring of tissue engineering processes in the European Union would require, in the opinion of the SCMPMD, specific legislation.
22. This proposal for a Directive, therefore, aims to ensure that tissues and cells used as source of these products should have the same level of quality and safety, compared with classical transplantation. In this way, the Directive will help to facilitate indirectly their movement from one Member State to another. In addition, by establishing the same procurement, processing, and storage criteria, as well as the setting up of a Community register of accredited tissue banks, the Directive will help to remove uncalled-for restrictions on the exchange of tissues from one Member State to another.
23. This proposal 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. If, however, any particular use of such cells is authorised in a Member State, this proposal will require the application of all provisions necessary to protect public health and guarantee respect for fundamental rights.
24. The therapeutic use of human tissues and cells involves a considerable number of complex and interrelated activities, extending from donor-suitability evaluation to the implantation of the graft, or the manufacturing of a product. Any prospective legislation must take all these steps into account, while respecting the responsibilities of the Member States for the organisation and delivery of health services and medical care.
25. This proposed Directive respects the different organisational structures established in Member States. In some, procurement is carried out only by tissue banks, while in others responsibility is shared by both procurement centres and the tissue banks. This proposal respects the authority of the Member States for granting accreditation to those establishments involved in tissue procurement while it sets out the high standards of quality and safety that must be met.
26. This proposed Directive seeks to ensure a high level of quality and safety throughout the tissue and cells transplantation chain in all Member States, bearing in mind the freedom of movement of citizens and goods within the European Union. The establishment of quality and safety standards will help to reassure the public that human tissues and cells that are derived from donations in another Member State nonetheless carry the same guarantees as those in their own country.
27. In order to arrive at such standards, the proposed Directive requires the establishment of comparable national inspection and accreditation structures, as well as equivalent training for the personnel involved throughout the chain. The specific training provisions envisaged in this proposed Directive, however, are without prejudice to the legislative requirements concerning mutual recognition of diplomas.
28. Establishment of a system to ensure that all tissues and cells could be traced from donor to recipient and vice versa is an essential aim of this proposed Directive. It also establishes a system to monitor adverse reactions and events associated with the procurement, processing and use of tissues and cells in the European Union.
29. Importation of tissues and cells from third countries is on the increase. In order to protect the health of patients in the European Union, it is necessary to ensure that high standards of quality and safety are also applied to these imports. Due to the rapidity with which technology is evolving in this area, it will help Member States if appropriate EU procedures to ensure quality and safety for imports and exports of these human substances are developed. As a general principle, imports from and exports to from third countries should only be carried out by accredited tissue banks, supervised by the competent authority. Authorisation should be granted only if at least equivalent standards are met by the tissues and cells imported or exported. The Directive provides for a mechanism to establish an EU procedure that will allow a coherent approach to the authorisation of imports and exports.
30. Procurement, evaluation, and selection of the donor are the first and decisive steps in the transplantation chain. Donors are directly involved in these processes that are often conducted outside tissue banks. This proposed Directive will establish high standards of quality and safety for the processes associated with the selection and evaluation of the donor and procurement of the tissues and cells in order to ensure the health of recipients.
31. The use of human tissue and cells should take place under conditions protecting the rights and health of donors, potential donors, and recipients. This Directive protects their dignity and identity and established the principle that parts of the human body as such being used for tissue and cells procurement, or exchange and allocation activities should not give rise to financial gain.
32. It is generally accepted in all Member States that tissue and cell donation should be voluntary and unpaid. For germ cell donation, however, current practice does not always reflect this rule. The Commission considers that a Directive on tissues and cells should endorse application of this ethical principle, which is cited in texts both of the Council of Europe and the European Group of Ethics.
33. Consent for procurement is in general regulated by Member States in very different ways. Their legislation ranges from presumed consent to others regulations where consent of relatives is needed The Commission believes that in a field very much identified with ethical questions it would be inappropriate to attempt to resolve such issues under a Directive based on Article 152 which addresses public health issues. However, the procurement of human tissues and cells must fully respect the Charter of Fundamental Rights of the European Union, and take fully into account the principles of he Convention of Human Rights and Biomedicine. The Convention states that consent for living donors should be given expressly and freely, in writing prior to the donation. This Directive specifies that procurement human tissues or cells shall be carried out only after all mandatory consent requirements in force in the Member State are met.
34. This proposed Directive reflects the importance of tissue banks, which have responsibility for the processing, preservation, internal quality control, storage, and distribution of the procured human tissues and cells, and must ensure the quality and safety during the entire process.
35. In 1994, the Council of Europe adopted Recommendation R 94/1 i, which addresses activities relating to the banking of human tissues (and cells). It recommends that: tissue banks should be officially licensed by national health administrations, or recognised by the competent authorities; that they should ensure that tissues are tested for transmissible diseases and stored safely; that records of all tissues retrieved and issued should be kept; that distribution should permit optimal use based on equal access; and that close co-operation should be ensured between all recognised exchange and tissue banking organisations. This Recommendation is fully taken into account in this proposal for a Directive.
36. Recommendation R 94/1 recommends that tissue procurement should be carried out on a not for profit basis-making, but in case of a public health need an authorised profit-making body may exist. This is in line with the opinion of the EGE, which expressed that: in principle, tissue bank activities should be reserved to public health institutions or non profit-making organisations. In such cases, this means that the delivery price should only cover the banks expenses relating to the tissues in question. Nevertheless, given the current state of development of the sector, it is difficult to exclude tissue-banking activities by commercial organisations, such as large private laboratories. This is particularly true where human tissues are used as a basis for engineered products requiring the use of sophisticated medical techniques. Tissue banks set up by industry, however, should be subject to the same licensing and monitoring requirements as non-commercial operators'. Taking into account these opinions, this proposal suggests that Member States shall encourage non-profit tissue banks, without introducing a strict legal obligation.
37. The proposal contains measures to ensure that technical requirements and standards keep pace with scientific progress. To this end, a new Regulatory Committee of Member State representatives is established. This procedure will be used for regularly updating the technical annexes of this Directive, in particular in view of technical and scientific progress, and emerging risks of transmission of communicable diseases. In the preparation of regularly updated standards, the Commission intends to collaborate closely with the Council of Europe, the World Health Organisation, and other relevant international bodies.
Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use. (OJ L 311, 28.11.2001, p. 67-128)
Directive 2000/70/EC of the European Parliament and of the Council of 16 November 2000 amending Council Directive 93/42/EEC as regards medical devices incorporating stable derivates of human blood or human plasma. (OJ L 313, 13.12.2000, p.22.)
Directive 98/79/EC of the European Parliament and of the Council of 27 October 1998 on in vitro diagnostic medical devices. (OJ L 331, 7.12.1998, p.1)
Council Directive of 93/42/EEC of 14 June 1993 concerning medical devices. (OJ L 169, 12.07.1993)
Council Regulation (EEC) No 2309/93 of 22 July 1993 laying down Community procedures for the authorisation and supervision of medicinal products for human and veterinary use and establishing a European Agency for the Evaluation of Medicinal Products. (OJ L 214, 24.08.1993, p.1)
Council Directive 90/385/EEC of 20 June 1990 on the approximation of the laws of the Member States relating to active implantable medical devices (OJ L 189, 20.07, 1990, p.17)
Council Decision 87/67/EEC of 26 January 1987 accepting on behalf of the Community the European agreement on the Exchange of Therapeutic Substances of Human Origin. (OJ L 37, 7.02.1987, p.1)
Commission Regulation (EC) No 540/95 of 10 March 1995 laying down the arrangements for reporting suspected unexpected adverse reactions which are not serious, whether arising in the Community or in a third country, to medicinal products for human or veterinary use authorised in accordance with the provisions of Council Regulation (EEC) No 2309/93. (OJ L 55, 11.03.1995, p.5)
TABLE 1
>REFERENCE TO A GRAPHIC>
Protection of the donor. Percentage of reporting Member States (n=11) that have mandatory requirements
2. Respect for the anonymity of donor / recipient.
3. Specific rules for expressions of consent for living donors.
4. Specific rules for minors.
5. Family consent required for deceased donor.
Suitability of the donor.
Percentage of reporting Member States (n=12) that have mandatory requirements
>REFERENCE TO A GRAPHIC>
Quarantine - Quarantine for living donor; Toxoplasmosis - Test for the detection of toxoplasmosis; Anti EBV - Epstein Bar Virus antibodies; Anti CMV - Cytomegalovirus antibodies; Syphilis - Treponema Pallidum; Anti HTLV - Human T Lymphotrophic virus antibodies; ALAT - Alanin Aminotransferase enzyme; Anti HBS - Hepatitis B virus antibodies (surface); Anti HBC - Hepatitis B virus antibodies (core); HBV Ag - Hepatitis B virus Antigen; Anti HCV - Hepatitis C virus antibodies; HIV Ag - Human Immunodeficiency Antigen; Anti HIV - Human Immunodeficiency virus antibodies; Use of authorised laboratories; Use of authorised test; Requirement for physical examination; Consultation of medical records.
Other regulatory aspects.
Percentage of reporting Member States (n=13) that have mandatory requirements
>REFERENCE TO A GRAPHIC>
1. Required authorisation for procurement establishments.
2. Required authorisation for processing organisations.
3. Standards for processing.
4. Standards for transport.
5. Standards for retrieval.
6. Required inspection.
7. Authorisation for import / export.
8. Reporting adverse events.
A. AIMS
The aims of this proposal are to:
- establish European Community legislation setting standards for the quality and safety of tissues and cells of human origin used for application in the human body;
- strengthen requirements related to the suitability of donors of tissues and cells and the screening of donated substances of human origin in the European Union;
- establish at Member State level requirements for establishments involved in the procurement, testing, processing, storage, and distribution of tissues and cells of human origin, as well as national accreditation and monitoring structures;
- lay down provisions at Community level for the formulation of a register of accredited establishments;
- lay down provisions at Community level for the formulation of a quality system for tissues and cells related establishments;
- lay down common provisions at Community level for the training of staff directly involved in the procurement, testing, processing, storage, and distribution of tissues and cells of human origin, without prejudice to existing legislation;
- establish rules for ensuring the traceability of tissues and cells of human origin from donor to patient and vice versa, which are valid throughout the European Union;
- establish a system for the regulation of imports of human tissues and cells from third countries that ensure equivalent standards of quality and safety.
The legal basis for this proposal is Article 152 of the Treaty, in particular (4)(a), which requires the European Parliament and the Council to adopt measures that set high standards of quality and safety of substances of human origin.
In accordance with the principles of subsidiarity and proportionality, European Community actions in the public health field should be undertaken only if their objective cannot be sufficiently achieved by the Member States and can therefore, by reason of their scale and effects, be better achieved by the EC. This is reinforced in Article 152 which states that Community public health action shall fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care.
Article 152, however, goes on to specify in (4)(a) that measures should be adopted setting high standards of quality and safety of organs and substances of human origin, blood and blood derivatives. In the light of this, actions should address issues that have a trans-national dimension, where common approaches are required, or where there is a need for effective co-operation and co-ordination.
The measures set out in this proposed Directive incorporate requirements for the procurement, testing, processing, storage, and distribution of tissues and cells of human origin intended for application in the human body. They do not prevent Member States from maintaining or introducing more stringent protective measures, in conformity with the Treaty, and do not affect national provisions on the donation or medical use of tissues and cells of human origin.
In contrast to existing European Community procedures concerning the approximation of laws, regulations and administrative provisions relating to proprietary medicinal products, this proposed Directive does not have as its primary objective the placing on the market of tissues and cells of human origin. It will, however, mean that national provisions resulting from the transposition of this proposed Directive will result in homogeneity of technical requirements of quality and safety within the Member States once it has been adopted.
This proposed Directive, in particular, establishes an equivalent system of notification and accreditation for establishments involved in the procurement, testing, processing, storage, and distribution of tissues and cells of human origin in the Member States. Although criteria for this system are laid down in this proposed Directive, detailed rules remain the responsibility of the Member States.
The impact of this proposed Directive, once adopted and transposed in the Member States, will establish a minimum regulatory and administrative foundation that will facilitate the exchange of tissues and cells of human origin in the European Union.
In ensuring an equivalent collection of data on any incidents arising during the donation, procurement, testing, processing, storage, and distribution of tissues and cells of human origin, this proposed Directive will simplify the exchange of information in this field between the Member States.
This proposed Directive is complementary to European Community legislation relating to the quality and safety of human blood and blood components. It is intended to ensure the same level of quality and safety of tissues and cells used for application in the human body.
This proposal for a Directive takes account of the most recent progress made and agreements attained at international level, particularly within the World Health Organisation and the Council of Europe.
In addition, there have been a number of consultations with competent technical experts and with representatives of the Member States in its preparation. Most of the organisations interested in the field have been consulted, such the European Association of Tissue Banks, the European Association of Musculoeskeletal Transplantation, the European Eye Bank Association, the European Group for Bone Marrow Transplantation, the Donor Bone Marrow Association, Europdonor Foundation, representatives of the industry and patients associations.
The objective of this proposed Directive is to establish a legislative foundation for the European Community setting a high level of quality and safety of tissues and cells of human origin. The provisions envisaged deal with the greater part of the tissues and cells transplantation process from donor identification to the distribution of these substances for therapeutic use. It excludes, however, those aspects related to the manufacturing of products as well as the actual clinical use of tissues and cells of human origin.
The proposed measures are presented in seven chapters as well as seven technical annexes.
The seven chapters can be divided into four distinct parts. One comprising provisions of a general nature (chapters I and II); one dealing with technical aspects, which include requirements for donor selection and evaluation, tissues and cells procurement, and provisions for the quality and safety of the processing, storage and distribution (chapters III and IV). A part regulating data protection requirements, exchange of information between the Member States, reports and penalties (chapter V); and finally a part regulating committee consultations, the adaptation of the annexes to technical progress, and the implementation of the text (chapters VI and VII).
The scope of the proposal encompasses the donation, procurement, and testing of human tissues and cells for application to the human body. Its provisions are also applicable to the processing, preservation, storage and distribution of these substances when they are to be used for human transplantation. Blood and blood components, as defined in the proposed blood Directive, organs, and human tissues and cells used as an autologous graft within the same surgical procedure, are excluded from this proposed Directive. The procedures involved in the manufacturing of medicinal products and medical devices are also excluded. The definitions and terminology used are widely accepted and employed and are presented in Article 3. An obligation is introduced in Articles 5 to 11 of the proposed Directive, requiring Member States to set up a notification system including accreditation and inspection and control of tissue banks as well health care establishments where the procurement of tissues is carried out. A registration process for accredited health care establishments must also be set up as well as a procedure to ensure equivalent standards of quality and safety for human tissues and cells imported from third countries. It is necessary that the competent authority in the Member States ensure effective implementation of the Directive's provisions, once adopted.
In order to maintain a high level of quality and safety for the donation, procurement, and testing, specific provisions are set out in Articles 12 to 15 referring to the technical annexes, which cover the evaluation and selection of donors, and the procurement of the tissues and cells of human origin. These specific provisions take into account international standards (e.g. Council of Europe, World Health Organisation, European Association of Tissue Banks, and national standards), as well as the advice of experts from the Member States. In addition, provisions are set up regarding the protection of donor rights.
Provisions in order to ensure a high level of quality and safety for the processing, preservation, storage, and distribution of human tissues and cells are set up in Articles 16 to 25 referring to the technical annexes. In these provisions, staff training and the adoption of a quality control system to be established in these health care establishments are envisaged.
As a contribution to ensuring safety and quality throughout the tissues and cells transplantation process, an information exchange system needs to be established between Member States. To be effective, this system has to rely on traceability of tissues and cells of human origin throughout the transplantation process, using suitable labelling as well as using a system of conservation of the files. This labelling and the adoption of provisions concerning the maintenance of the files foreseen in Articles 7, 13 and 26, will facilitate any action that may need to be taken upstream in the chain in the event of downstream incidents and will highlight any event occurring, after donation, in the transplantation chain.
Lastly, in view of rapid scientific developments related to the safety and quality of tissues and cells of human origin, continual and rapid adaptation of the proposal's annexes to technical progress has to be foreseen. A committee procedure is envisaged in Article 28 to address this. Such adaptations will be carried out on a solid scientific basis. The Commission intends to collaborate closely with the Council of Europe when these adaptations are developed, in order to ensure coherence with the recommendations it develops in the same field.