The Declaration is not a legal document, nor did those involved in its creation sign it. Rather than compelling compliance with the principles of the declaration, it is hoped that the principles and the proposals it outlines will guide and inspire better practices in transplantation. With this in mind, endorsement of the Declaration has been sought amongst the many professional societies associated with transplantation medicine.

Societies that officially endorse the Declaration are urged to uphold the principles of the Declaration in their activities and in the practice of their members. They are further encouraged to strive towards achievement of the proposals suggested in the Declaration.

Endorsement not only promotes ethical practice within particular professional societies, it helps to convey the weight of public and professional support for the Declaration, thus encouraging health authorities and policy makers to adopt legislation and support activities that facilitate the goals of the Declaration.

Endorsement of the Declaration does not entail compliance with all the proposals it suggests, however it does require those who endorse it to rigorously apply the ethical principles of the Declaration in their policies, practice and activities. To facilitate this, the following suggestions have been made for organizations which endorse the Declaration:

• require that speakers at scientific and educational meetings on clinical organ transplantation disclose whether the clinical and research activities being reported are consistent with the Principles of the Declaration of Istanbul.
• have an established mechanism for determining the appropriateness of accepting presentations on clinical organ transplantation based on the disclosure of a consistency with the Principles of the Declaration of Istanbul.
• establish mechanisms to promote, implement and uphold the Declaration (for example, through ethics committee activity, awards and membership criteria).