Organ, Tissue and Cell Donation and Transplantation (OTCDT) is a medical procedure in which an organ, tissue or cell is removed from one body and placed in the body of a recipient to replace a damaged or missing structure. Transplantation involves organs, tissues and cells such as the kidneys, liver, lungs, pancreas, heart, small bowel, stem cells, bone marrow, cornea, sclera, skin and reproductive tissues including eggs, ovaries, sperm, testicles and the uterus, among others.
Globally, OTCDT is recognised as a life-saving medical intervention. However, across Africa, only a limited number of countries have established legal requirements governing organ, tissue and cell transplantation. Even where such frameworks exist, they are often restricted to living donors, with minimal or no provisions for recipients and deceased donors.
The absence of comprehensive legal and regulatory frameworks has left critical ethical, safety and justice concerns unresolved, compromising patient care and exposing vulnerable populations to exploitation. The World Health Organisation (WHO) has consistently underscored the need for countries to implement legal standards to govern donation and transplantation, ensuring quality, safety, traceability and public trust. Yet the majority of African states either lack such frameworks entirely or enforce only partial provisions.
Similarly, the Declaration of Istanbul on Organ Trafficking and Transplant Tourism—a globally endorsed ethical guide—emphasises the necessity of transparent legal systems to combat illegal organ sales and transplant tourism, insisting that transplantation must be guided by equity and respect for human dignity.
Understanding “transplant forensics”
“Transplant forensics” refers to the application of forensic science, medico-legal principles and investigative oversight to organ, tissue and cell donation and transplantation. Its objective is to ensure that every donor and transplant process is lawful, ethical, traceable and scientifically verifiable.
This approach encompasses standardised death determination, identity confirmation, comprehensive documentation, chain-of-custody of human biological materials, and the investigation of suspected trafficking, coercion or malpractice.
In the African context—and particularly in Ghana—transplant forensics is critical to protecting vulnerable populations, strengthening public trust and embedding accountability within emerging transplantation systems.
In practice, transplantation processes are often complicated by competing interests between forensic investigators and organ donation networks. While the role of forensic professionals in living donation is well recognised, cadaveric or deceased donation is equally significant.
Research has demonstrated the value of integrating forensic examiners into transplant surgical teams, with forensic professionals conducting initial investigations into a patient’s death and collecting samples for forensic screening. Early involvement allows the judicial process to commence promptly, ensuring the preservation of vital physical evidence without obstructing the donation of viable organs to patients in need.
Current legislation in African states
Only a handful of African countries have enacted comprehensive OTCDT legislation. Uganda’s Human Organ Donation and Transplant Act, 2023 stands out as one of the most detailed legal frameworks on the continent. It establishes a regulatory council responsible for overseeing donation processes, accrediting transplant centres, ensuring equitable access, enforcing traceability and consent standards, and imposing punitive measures against organ trafficking.
In contrast, countries such as Kenya have developed national policies or authorities—such as the Kenya Tissue and Transplant Authority—but have yet to fully operationalise comprehensive legislation covering procurement, distribution, ethical oversight and enforcement.
South Africa relies largely on broader health legislation, including the National Health Act, which contains scattered provisions on organ donation and consent but lacks a dedicated transplantation regulatory framework.
Across most of Africa, legislative action lags behind need. Existing laws are fragmented, weakly enforced and rarely mandate forensic oversight, traceability systems or standardised death determination protocols essential to protecting both donors and recipients.
Deficiencies in policy and law
The current patchwork of legal and policy frameworks across Africa suffers from several critical deficiencies:
Inadequate legal structures:
Many countries lack dedicated OTCDT statutes or rely on outdated provisions that fail to establish clear authorities for licensing, enforcement and quality assurance. This creates gaps in traceability, enables illicit trade and weakens the prosecution of abuses.
Weak ethical and oversight mechanisms:
Without empowered national transplant authorities to manage waiting lists, monitor consent and enforce standards, donor and recipient rights are at risk. The Declaration of Istanbul recommends jurisdiction-specific legislation aligned with international ethical norms to ensure fairness and transparency.
Absence of forensic oversight and death determination standards:
Most laws fail to integrate medico-legal requirements such as standardised brain and circulatory death determination, formal documentation of donor death and forensic investigation where necessary. These gaps threaten public trust, particularly in regions with underdeveloped death investigation systems.
Limited public awareness and education:
The lack of coordinated public education strategies perpetuates misconceptions and cultural resistance, reducing donation rates even where legal reforms are underway.
Why Ghana must lead legislative reform
In Ghana, OTCDT reform has entered the legislative arena with increasing urgency. Parliamentary debates in 2025 highlighted the absence of a formal legal and regulatory framework governing organ and tissue transplantation, despite the existence of limited services in some health facilities.
Lawmakers emphasised that comprehensive legislation would enable accreditation of transplant centres, prevent illegal dealings and ensure equitable access to life-saving transplant services.
However, any proposed law must go beyond basic regulation. To meet international standards and best practices, Ghana’s OTCDT framework must:
- Establish a National Transplant Council or Agency, working in collaboration with the National Forensic Authority, to regulate procurement, storage, distribution and transplantation.
- Mandate forensic death determination standards aligned with global medico-legal principles for deceased donors.
- Create national donor and recipient registries incorporating biometric data, traceability mechanisms and adverse outcome reporting.
- Enforce strong anti-trafficking provisions consistent with WHO and Declaration of Istanbul principles to combat organ trafficking and transplant tourism.
Conclusion
The ethical, legal and scientific complexity of organ, tissue and cell transplantation demands more than fragmented regulation. African nations, including Ghana, stand at a critical crossroads.
Comprehensive OTCDT legislation—integrating forensic oversight, traceability, ethical accountability and public trust mechanisms—is no longer optional. As global institutions such as the WHO and the United Nations advocate for safe and transparent systems, African legal reformers have a unique opportunity to lead.
Protecting donors and recipients alike requires ensuring that the gift of life through transplantation is matched by the rule of law, human dignity and justice.
By Dr L. K. Acheampong, Prof. Francis Agyemang Yeboah & Prof. Paul Poku Sampene Ossei
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