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.

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.

FAQs

What is the DICG?

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.

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