Policy on Meeting Content for Use by Organizations that Have Endorsed The Declaration of Istanbul on Organ Trafficking and Transplant Tourism
The following recommendations are based on practical experience obtained during the preparation of the academic content of meetings sponsored or supported by The Transplantation Society. These recommendations do not intend to prevent academic examination of controversial issues in organ transplantation. Rather, they aim simply aim to ensure that the organizations that have endorsed the Declaration of Istanbul do not confer academic prestige or professional acceptance on individuals or groups whose actual practices undermine the objectives of the Declaration of Istanbul or involve the use of organs or tissues from executed prisoners. The denial of approval to such individuals and groups seeks particularly to promote ethical and effective organ transplant practices in countries that are struggling to overcome organ trafficking and transplant tourism.
All abstract submission forms should include a statement to the effect that: "The authors attest that (a) all data (clinical findings, description of clinical material, etc.) were derived from research and clinical activities carried out in accordance with the principles of the Declaration of Istanbul and (b) executed prisoners were not the source of organs or tissues in any of the activities reported."
Abstract reviewers should be instructed to pay particular attention to submissions from countries designated by the World Health Organization as organ trafficking "hotspots."
Abstracts that raise concern should be "tagged" and reviewed by the meeting's program planners. The authors of tagged abstracts should be notified of the questions raised concerning their submissions and should be asked to respond to the questions and to confirm that the activities reported were carried out consistently with the Declaration of Istanbul. Should the response received from the authors be unsatisfactory (or absent), the abstract should be rejected.
The restrictions applicable to authors of abstracts should also be applied to invited speakers. The simplest means of conveying the expectation that such speakers will not present data from activities that are inconsistent with the principles of the Declaration of Istanbul is to ask each speaker to include the statement in Point 1 in his or her acceptance letter. Further, program planners should not invite any person known to have engaged in activities that are inconsistent with the Principles of the Declaration of Istanbul or that rely on organs or tissues from executed prisoners to address the meeting (other than to participate in a discussion of the merits of the Declaration or a comparable issue) unless such person has provided credible assurance that he or she no longer engages in such activities.
The Mission of the Declaration of Istanbul Custodian Group (DICG) is to promote, implement and uphold the Declaration of Istanbul so as to combat organ trafficking, transplant tourism and transplant commercialism and to encourage adoption of effective and ethical transplantation practices around the world.
WORLD DAY AGAINST TRAFFICKING IN PERSONS
The DICG is participating in the WDATP campaign. We invite you to share our posters and website.
The Mission of the Declaration of Istanbul Custodian Group (DICG) is to promote, implement and uphold the Declaration of Istanbul so as to combat organ trafficking, transplant tourism and transplant commercialism and to encourage adoption of effective and ethical transplantation practices around the world.
Our Story
Our Story
Organ transplantation is one of the greatest medical success stories of
the twentieth century. It has prolonged and improved the lives of
hundreds of thousands of patients worldwide, thanks to generous organ
donors, and dedicated scientific and clinical health professionals.
The Problem
The Problem
In 2007 it was estimated that up to 10 percent of organ transplantations worldwide involved people who were trafficked, forced, coerced, paid, or incentivized for removal of their vital organs. These organs were used for patients who needed a transplant and travelled to purchase them for transplantation. The donors were vulnerable to exploitation and in many cases suffered permanent health complications because of this unethical practice.
Most patients who travelled to purchase and receive these organs came from wealthy countries. It should be noted that their health outcomes were generally worse than patients who received transplants in their own countries.
How We Started
How We Started
The Declaration of Istanbul was developed in response to this urgent situation at a summit meeting held in Istanbul in April 2008. The international assembly of 151 participants included scientific and medical bodies, government officials, social scientists, and ethicists. Their objective was to address the growing problem of human trafficking and tourism for the purpose of organ transplantation. The Declaration of Istanbul Custodian Group was created in 2010 to advance the goals established at this meeting and to respond to new challenges in organ trafficking and transplant tourism.
Our Goals
Our Goals
The Declaration of Istanbul was updated in 2018 to reflect the evolving goals of organ donation and transplant professionals. It was determined that everyone in need should benefit from transplant, regardless of where they live, without relying on unethical and exploitive practices. This declaration continues to provide ethical guidance and support for medical professionals, policymakers, professional societies, national health authorities, and inter-governmental organizations such as the World Health Organization, the United Nations, and the Council of Europe.
The Results
The Results
The Declaration of Istanbul has contributed to considerable progress since 2008 to reduce trafficking, commercialism, and tourism for organ transplantation in countries around the world. The DICG is continuing their work to help countries achieve organ donation and transplantation self-sufficiency. Their goals are
for countries to:
meet their own citizens’ needs, and within their own country.
use organs donated by its residents, or by equitably sharing resources with other countries.
achieve financial neutrality in organ donation so that donors and their families neither lose nor gain financially because of their donation.
How You Can Help
How You Can Help
The DICG’s goals continue to evolve to reflect current global needs. You can be part of the solution to end organ trafficking and tourism in transplantation by:
Reading the Declaration of Istanbul
Watching our educational videos
Studying our Resource materials
Downloading and sharing the patient brochure
Alert us when you witness or hear of unethical organ transplantation practices
Interview in Transplantation about DICG co-chairs Sanjay Nagral and Thomas F. Mueller
The DICG’s cochairs, Sanjay Nagral, MB, BS, MS and Thomas F. Mueller, MD, PhD, are featured in the December 2023 issue of the Journal Transplantation. Check out this informal Q&A to learn how they started in medicine and surgery, how their research in kidney transplantation impacts their clinical practices and about their work with the DICG. Their answers on the impact and evolution of the Declaration of Istanbul are encouraging and insightful.
The Declaration of Istanbul Custodian Group (DICG) is a group of leading medical experts from around the world. They are sponsored by the Transplantation Society (TTS) and the International Society of Nephrology (ISN) and endorsed by more than 80 international professional societies and governmental agencies. This group understands how desperate many patients feel when they need a lifesaving organ transplant. They know that many would consider traveling to another country to obtain that organ. However, they also understand that many organ donors in poor countries are exploited, trafficked, forced, paid, or incentivized for removal of their vital organs, and in many cases,
suffer permanent health complications.
That’s why because of their organ donatiothe DICG developed strategies to prevent organ trafficking and transplant tourism. They created principles and proposals to promote donor transplantation around the world in ways that end exploitation and protect both donors and recipients. Their policy document is called The Declaration of Istanbul.
What transplant organs is the DICG focused on?
The DICG is concerned about all types of organ trafficking, tourism, and transplant, including kidney, liver, heart, pancreas, lung, and small bowel. Kidney, liver, pancreas, lung, and small bowel transplants can be donated by both living and deceased donors. Heart transplants only come from deceased donors. Of the 146,840 organ transplants reported globally (estimated in 2018), 36% were living kidney transplants and 19% were living liver transplants.
Lung, pancreas, and bowel transplants are rare.
What is transplantation?
Transplantation is a sophisticated surgical procedure performed by an experienced team of surgeons and specialists in an advanced hospital environment. For many patients with end- stage kidney disease, transplantation is the treatment of choice.
Where do kidney transplants come from?
Kidney transplants can come from a deceased or living donor. The availability of a deceased donor kidney depends on practices specific to each country. A living kidney donor is typically a close blood relative, but in some countries, it can sometimes be a spouse, partner, or friend. Donation must be done willingly, and donors must be medically compatible with the person receiving their organ. These types of transplants are legal and typically have excellent medical and psychological results for both the donor and the recipients.
What is transplant tourism?
Transplant tourism means leaving your country of residence to undergo transplantation. Most medical professionals disapprove of transplant tourism because the level of health care received is likely to be inferior to the care you would receive in your own country.
What is organ trafficking?
Organ trafficking is the recruitment, transportation, transfer, harboring, or receipt of people, by threat, force, coercion, abduction, fraud, deception, abuse of power or vulnerability, or giving or receiving payments or benefits to achieve the consent of a person who has control over another person, for the purpose of the removing their organs. Organ trafficking almost always happens to the most vulnerable and easily exploited people. Many suffer from
significant health complications as a result of organ removal.
Why is organ tourism dangerous?
Organ tourism is typically illegal, so surgeries for donation and transplant are usually performed in hospitals and clinics that aren’t licensed to perform transplants or recognized by official medical boards. These facilities might not meet acceptable surgical and medical standards of care. Hygiene in the operating room or hospital might be sub-standard. Staff might be poorly trained. Access to antibiotics and other necessary medications might be limited. Pre-surgical health screening might be inadequate. Post-surgical travel can be dangerous. All of these and other
conditions present increase risks for complications that include infection and death.
What should I do if I need an organ transplant?
You should identify resources and discuss options with your own medical providers and transplant professionals. These experts can identify whether you are a good candidate for transplantation and the best resources for healthy, ethical, and effective organ donation.
