Policy & Ethics
The mission of The Transplantation Society is to provide global leadership in the practice of human transplantation. The responsibility of The Transplantation Society is to establish guidelines of clinical practice, advance programs of education, and to promote ethical standards for clinical care and scientific investigation.
Dr. Beatriz Domínguez-Gil,
Chair of the Ethics Committee
An increasing number of patients worldwide are in need of an organ for transplantation. Organ transplantation from deceased donors should be fostered by the recovery of organs after the determination of either brain death or cardiac death. However, The Transplantation Society recognizes that the burden and opportunity for successful organ transplantation is now regularly placed upon the willingness of a live and well human being to provide a kidney or a portion of the liver for transplant recipients with end stage organ failure. Live organ transplantation now also includes the transplantation of a lobe of the lung, and a portion of the pancreas or intestine.
The widespread acceptance of live organ transplantation is clearly counter to what historically has been a medical dictum to do no harm. Because of the emerging hazard for some individuals who are medically well and volunteer to donate an organ for transplantation, forums in Amsterdam and Vancouver were developed by The Transplantation Society to present definitive and timely statements regarding the responsibility of the transplant community to care for the live organ donor (1, 2). The ethics of a continuing practice of live organ transplantation demands an international recognition that prioritizes a sustained well being of the donor despite the life saving transplant that may be provided by the donor for the recipient (3, 4). The person who gives consent to be a live organ donor should be competent, willing to donate, free of coercion, medically and psychosocially suitable, fully informed of the risks and benefits as a donor, and fully informed of risks, benefits, and alternative treatment available to the recipient (5).
The Council of The Transplantation Society first addressed commercialization or brokerage of transplantable organs more than 20 years ago to declare its opposition (6). If the organ donation process were to be relegated to the laws of the market place, the less privileged might be exploited to improve the health of the more privileged, and the established safeguards surrounding altruistic donation would be compromised. Thus, guidelines were developed by the Council of The Transplantation Society that have been sustained to date: "No transplant surgeon/team shall be involved directly or indirectly in the buying or selling of organs/tissues.” This position is reiterated in the current policy statement provided to member applicants, namely that: "organs and tissues should be freely given without commercial consideration or financial profit."
Transplant tourism is a recently described phenomenon that may entail exploitive practices of organ transplantation for recipients who travel outside their country of residence to purchase an organ from a vendor. A practice of transplant tourism that has no transparency or professional oversight violates ethical principles of care. The Transplantation Society is opposed to practices of transplant tourism that exploit donors and recipients.
The Transplantation Society is opposed to the recovery of organs from executed prisoners. It is a fundamental principle for The Transplantation Society that organs and tissues are given freely and without coercion. Because of the restrictions in liberty in a prison environment, it is unlikely that prisoners are truly free to make independent decisions and thus an autonomous informed consent for donation cannot be obtained. Further, the financial incentive for recovering organs from executed prisoners may become an incentive to increase the number of such organs available for transplantation.
Scientific and clinical studies of human transplantation should be conducted with Institutional Review Board approval and adhere to the Helsinki Declaration of the World Medical Association: Ethical Principles For Medical Research Involving Human Subjects (7).
Scientific and clinical studies of xenotransplantation should adhere to the ethical principles set forth by the International Xenotransplant Association (8).