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The history and development of the Declaration of Istanbul

Development of the 2008 Declaration

In 2004, the World Health Assembly urged member states to take measures to protect the poor and vulnerable from transplant tourism and to address the wider problem of international trafficking of human organs and tissues.

In December 2006, concerned by the ongoing problems of international organ trafficking and the global shortage of organs for transplantation, representatives from The Transplantation Society met with representatives of the International Society of Nephrology and conceived the idea of developing a formal Declaration that would serve to inspire and unite all those engaged in combating unethical practices in organ transplantation. A Steering Committee was convened in Dubai and Ankara Turkey during 2007 which laid the foundations for the 2008 Istanbul Summit. The Summit goals were to assemble a final Declaration that would define organ trafficking, transplant tourism and commercialism, and achieve consensus regarding principles of practice and recommended alternatives to address the shortage of organs.

On April 30th 2008, more than 150 representatives of scientific and medical bodies from 78 countries around the world, including government officials, social scientists and ethicists were convened in Istanbul, Turkey to work on the drafting of the Declaration of Istanbul. Working groups were assigned to develop the various components of the Declaration and the results of their meetings were presented at plenary sessions for approval. The Declaration of Istanbul was derived from the consensus reached by the participants at the Summit in those plenary sessions.

The Declaration of Istanbul was first published on 5th July, 2008 in the Lancet. It has been subsequently published in several medical journals and translated into more than a dozen languages.

Participant Selection for the Istanbul Summit and the Steering Committee

The Steering Committee was selected by an Organizing Committee consisting of Mona Alrukhami, Jeremy Chapman, Francis Delmonico, Mohamed Sayegh, Faissal Shaheen, and Annika Tibell.

The Steering Committee of the Istanbul Summit was composed of leadership from The Transplantation Society (TTS), including its President-elect (Jeremy Chapman),  the Chair of its Ethics Committee (Annika Tibell), TTS Director of Medical Affairs (Francis Delmonico) and the representative leaders of the International Society of Nephrology (Mohamed Sayegh, Faissal Shaheen, and Mona Alrukhami) including its past President (William Couser), its Vice President (Bernardo Rodriguez Iturbe) and other individuals holding Council positions (Sarala Naicker.) The Steering Committee had representation from each of the continental regions of the globe with transplantation programs.

Participants at the Istanbul Summit included:

  • The country liaisons of The Transplantation Society representing virtually all countries with transplantation programs;
  • Representatives from international societies and the Vatican;
  • Individuals holding leadership positions in nephrology and transplantation;
  • Stakeholders in the public policy aspect of organ transplantation; and
  • Ethicists, anthropologists, sociologists, and legal scholars well-recognized for their writings regarding transplantation policy and practice.

No person or group was polled with respect to their opinion, practice, or philosophy prior to the Steering Committee selection or the Istanbul Summit. Of approximately 170 persons invited, 160 agreed to participate and 152 were able to attend the Summit .

Update and the 2018 Version Declaration

In 2017, the DICG began the process of reviewing and updating the DoI to ensure that it provided clear and current guidance for policymakers and health professionals working in organ donation and transplantation.

In February 2018, the DICG launched a public consultation inviting feedback on the draft updated to the Declaration. All DICG members, members of organizations that have endorsed the Declaration, and other interested stakeholders were invited to participate. More than 250 people from around the world participated in the working group and public consultation; approximately 65 submissions officially represented national or regional organizations. The response from the public consultation was overwhelmingly positive: participants welcomed the renewed commitment to combatting organ trafficking and transplant tourism, the updated and expanded definitions of key terms, and a clearer set of principles to guide policy and practice.

The new edition of the Declaration incorporating feedback from the public consultation was presented on 1 July 2018, in Madrid, at a DICG workshop celebrating the 10th Anniversary of the Declaration, as part of the 27th International Congress of TTS. The new edition has be published on the Declaration of Istanbul website, with translations into several languages, as well as in Transplantation.

A separate article discussing the 2018 Declaration was published in Transplantation Direct.

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