Organ Trafficking and Transplant Tourism and the Declaration of Istanbul: Editorial comment from The Lancet, Vol 372, 5 July 2008

A s i a n B i o e t h i c s R e v i e w M a r c h 2 0 0 9 Vo l u m e 1 , I s s u e 1 80 Organ Trafficking and Transplant Tourism and the Declaration of Istanbul Editorial comment from The Lancet, Vol 372, 5 July 2008 Organ trafficking, transplant tourism, and transplant commercialism, which threaten to undermine the practice of transplantation worldwide, were the focus of an international summit in Istanbul from April 30 to May 1, 2008. The summit was convened by The Transplantation Society and the International Society of Nephrology. The meeting resulted in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism (webappendix), which aims to halt these unethical activities and to foster safe and accountable practices that meet the needs of transplant recipients while protecting donors. The initial text of the declaration was prepared by a steering committee, which also invited medical and scientific professionals, representatives of governmental and social agencies, social scientists, legal scholars, and ethicists to participate in the meeting. None of the 152 participants from 78 countries was polled with respect to his or her opinion, practice, or philosophy before selection. The declaration was agreed by consensus among the summit’s participants. For more than two decades, governments around the world have recognised the need to protect poor people from the exploitation inherent in organ sales.1–4 Yet, partly as a consequence of the widespread shortage of organs and the increasing ease of internet communication, organ trafficking and transplant tourism have become global problems. Vulnerable populations (such as illiterate and impoverished individuals, undocumented immigrants, prisoners, and political or economic refugees) in resource-poor countries are now a major source of organs for rich patient-tourists who are prepared to travel and can afford to purchase organs.5 WHO has estimated that about 10% of organ transplants around the world involve these unacceptable activities and in some countries the rate is much higher (Noël L, WHO, Geneva, Switzerland; personal communication). 80–83 Asian Bioethics Review March 2009 Volume 1, Issue 1 U P D A T E 81 For example, by 2006, two-thirds of the 2000 kidney transplants in Pakistan were for foreign recipients.6 An essential first step in combating such activities is to describe them precisely. The declaration clearly defines organ trafficking, transplant commercialism, and transplant tourism. The declaration also proposes policies and principles of practice on the basis of the definitions: “Organ trafficking and transplant tourism violate the principles of equity, justice and respect for human dignity and should be prohibited. Because transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice and should also be prohibited.” To be effective, these prohibitions must include bans on all types of advertising (electronic and print), soliciting, or brokering for the purpose of transplant commercialism. The declaration describes universal approaches for the provision of care for the living donor, and also emphasises the need for effective practices that support organ donation from dead donors. Reimbursement of the documented costs incurred during the evaluation and performance of the donor procedure is part of the legitimate expense of transplantation and does not constitute a payment for organs. Governments should ensure the provision of care and follow-up of living donors, which should be no less than the care and attention provided for transplant recipients. For example, the provision of disability, life, and health insurance related to the donation event is an essential part of providing care for the donor in countries without social insurance systems. Countries from which transplant tourists originate, as well as those to which they travel to obtain transplants, are just beginning to address their respective responsibilities to protect their people from exploitation and to develop a national self-sufficiency in organ donation. Leadership and encouragement from transplant professionals would contribute greatly to governments taking effective action to adopt and then to enforce strong laws consistent with the declaration. Participants in the Istanbul meeting have already played major roles in the promulgation of such laws and regulations within the past 2 years in China, Pakistan, and the Philippines...