Consistent with these principles, participants in the Istanbul Summit suggest the following strategies to increase the donor pool and to prevent organ trafficking, transplant commercialism and transplant tourism and to encourage legitimate, life-saving transplantation programs:
To respond to the need to increase deceased donation:
- Governments, in collaboration with health care institutions, professionals, and non- governmental organizations should take appropriate actions to increase deceased organ donation. Measures should be taken to remove obstacles and disincentives to deceased organ donation.
- In countries without established deceased organ donation or transplantation, national legislation should be enacted that would initiate deceased organ donation and create transplantation infrastructure, so as to fulfill each country’s deceased donor potential.
- In all countries in which deceased organ donation has been initiated, the therapeutic potential of deceased organ donation and transplantation should be maximized.
- Countries with well established deceased donor transplant programs are encouraged to share information, expertise and technology with countries seeking to improve their organ donation efforts.
To ensure the protection and safety of living donors and appropriate recognition for their heroic act while combating transplant tourism, organ trafficking and transplant commercialism:
|1.||The act of donation should be regarded as heroic and honored as such by representatives of the government and civil society organizations.|
|2.||The determination of the medical and psychosocial suitability of the living donor should be guided by the recommendations of the Amsterdam and Vancouver Forums (2-4).|
|a.||Mechanisms for informed consent should incorporate provisions for evaluating the donor’s understanding, including assessment of the psychological impact of the process;|
|b.||All donors should undergo psychosocial evaluation by mental health professionals during screening.|
|3.||The care of organ donors, including those who have been victims of organ trafficking, transplant commercialism, and transplant tourism, is a critical responsibility of all jurisdictions that sanctioned organ transplants utilizing such practices.|
|4.||Systems and structures should ensure standardization, transparency and accountability of support for donation.|
|a.||Mechanisms for transparency of process and follow-up should be established;|
|b.||Informed consent should be obtained both for donation and for follow-up processes.|
|5.||Provision of care includes medical and psychosocial care at the time of donation and for any short- and long-term consequences related to organ donation.|
|a.||In jurisdictions and countries that lack universal health insurance, the provision of disability, life, and health insurance related to the donation event is a necessary requirement in providing care for the donor;|
|b.||In those jurisdictions that have universal health insurance, governmental services should ensure donors have access to appropriate medical care related to the donation event;|
|c.||Health and/or life insurance coverage and employment opportunities of persons who donate organs should not be compromised;|
|d.||All donors should be offered psychosocial services as a standard component of follow-up;|
|e.||In the event of organ failure in the donor, the donor should receive:|
|i. Supportive medical care, including dialysis for those with renal failure, and|
|ii. Priority for access to transplantation, integrated into existing allocation rules as they apply to either living or deceased organ transplantation.|
|6.||Comprehensive reimbursement of the actual, documented costs of donating an organ does not constitute a payment for an organ, but is rather part of the legitimate costs of treating the recipient.|
|a.||Such cost-reimbursement would usually be made by the party responsible for the costs of treating the transplant recipient (such as a government health department or a health insurer);|
|b.||Relevant costs and expenses should be calculated and administered using transparent methodology, consistent with national norms;|
|c.||Reimbursement of approved costs should be made directly to the party supplying the service (such as to the hospital that provided the donor’s medical care);|
|d.||Reimbursement of the donor’s lost income and out-of-pockets expenses should be administered by the agency handling the transplant rather than paid directly from the recipient to the donor.|
|7.||Legitimate expenses that may be reimbursed when documented include:|
|a.||the cost of any medical and psychological evaluations of potential living donors who are excluded from donation (e.g., because of medical or immunologic issues discovered during the evaluation process);|
|b.||costs incurred in arranging and effecting the pre-, peri- and post-operative phases of the donation process (e.g., long-distance telephone calls, travel, accommodation and subsistence expenses);|
|c.||medical expenses incurred for post-discharge care of the donor;|
|d.||lost income in relation to donation (consistent with national norms).|