February 9th, 2009

Dr. Francis L. Delmonico
Director of Medical Affairs

The Implications of Istanbul Declaration on Organ Trafficking and Transplant Tourism

Organ trafficking, transplant tourism and transplant commercialism are now defined by the Declaration of Istanbul and the Declaration provides principles of practice based on those definitions. Organ trafficking and transplant tourism should be prohibited because they violate the principles of equity, justice and respect for human dignity.

The implications of the Istanbul Declaration definitions, principles and recommendations are profound. They call for a legal and professional framework in each country to govern organ donation and transplantation activities. They call for a transparent regulatory oversight system that ensures donor and recipient safety and enforces the prohibitions of unethical practices.

Governments should ensure the provision of care and follow-up of living donors, be no less than the care and attention provided for transplants recipients. Professional societies should not continue to enable membership status for those individuals that violate the principles of the Declaration. Pharmaceutical companies and public and private funding agencies must affirm the Declaration in their consideration of clinical research support.

However, the Istanbul Declaration is not just about saying “no” to live donation. It supports the care of the live donor with programs that would make the experience for the donor not a monetary burden; and thus, cost neutral. Istanbul also emphasizes that the hard work of deceased donation cannot be set aside by a complacency that only uses the living donor.

Declaration of Istanbul (See commentary in The Lancet July 5th Issue)

As a result of a concerted action of the Philippine Society of Nephrology, the International Society of Nephrology, and The Transplantation Society, President Arroyo of the Philippines has issued an Executive Order to ban foreign patients from undergoing kidney transplantation in the Philippines. This development was also likely the result of the anticipated Istanbul Summit. The leadership of the Philippine Society of Nephrology participated in the Istanbul summit and contributed greatly to the drafting of the Istanbul Declaration also noted now on TTS website.

The Transplantation Society will be working with the representatives of each country to implement the principles and policies of the Istanbul Declaration and the revised guiding principles of the World Health Organization endorsed by the Executive Board of the WHO on May 29, 2008.

The Government of the Philippines issued an Administrative Order that would enable foreign patients to undergo kidney transplantation in the Philippines without restriction. The Philippine Society of Nephrology called upon the Philippine government to revoke this Administrative Order and to prohibit foreign patients from using the poor of the Philippines as a source of organs. The Transplantation Society and International Society of Nephrology have formed a mighty alliance in support of the Philippine Society of Nephrology. Please see attached the Administrative Order, the comments of the Philippine Society of Nephrology, and a letter that was sent from President Tilney and President Ritz representing TTS and ISN to the Government of the Philippines.

Administrative Order of the Government of the Philippines (March 2008)

Response of Philippine Society of Nephrology to the Administrative Order (March 2008)


New World Observatory Launched with Spain
(News Release WHO/12 – 30 March 2007)

Observatory link:
Username: rtictx\mcarmona
Password: Omsmc789

Global Knowledge Base link:

Transplant Tourism
Recipient and Vendor Trafficking

What should TTS do about these practices?

This statement was recently forthcoming from the WHO as component of the drafted guiding principles by Luc Noel:

"A shortage of organs, together with the high cost of health care in developed countries, has led to the growth of "transplant tourism", in which centres in some developing countries use the internet and other means to solicit patients to travel abroad to receive a transplant at a "bargain" price, "all donor costs included". Likewise, commercial traffic in organs - and even traffic in organ donors who leave their home countries in search of financial rewards for donating their kidneys- continues to be a serious problem, particularly in countries whose transplant programmes cater to foreign recipients. The occurrence of unethical practices (such as organ trafficking and transplant tourism) which take advantage of poor and vulnerable populations makes clear that better regulation is crucial if live donors are to be adequately protected from exploitation and physical harm".

At the recent Rotterdam conference on law and ethics of transplantation the following statement was developed:

"This congress condemns without reservation any practice that subverts or violates a potential donor's human rights or that involves coercion or deception. 'Trafficking in human beings' shall mean the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, or deception, of the abuse of power or of a position of vulnerability or of the giving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include....the removal of organs. (Art 4, Council of Europe Convention on Action against Trafficking in Human Beings).

Insurance companies in affluent countries are now the enablers of patients to go out of country to undergo transplantation from vendors or exploited to sell their organs.

These patients not infrequently return to the home country sick with tuberculosis hepatitis or HIV contracted that from organ donors inadequately screened. Transplantation. 2006 Nov 15;82(9):1130-5 Outcomes of commercial renal transplantation: a Canadian experience. Prasad GV et al.

The Transplantation Society is to work with the WHO to address this issue. Your thoughts would be welcome as to a resolve, keeping in mind that The Transplantation Society and the WHO are opposed to cash payments for organs.

TTS policy takes into account the experience of Iran and the economic forces that have made that markets what it is. Price fixing is not attainable. No international police could prevent price differences by gender and ethnicity and age of the vendor.

Vendors are now being shipped from one country to another; recipients are seeking best price from one country to another.

Again we look to replies as to what solutions TTS could endorse with the WHO.

Please email to Filomena Picciano (This email address is being protected from spambots. You need JavaScript enabled to view it. ) or myself (This email address is being protected from spambots. You need JavaScript enabled to view it. ), we look forward to your responses and input.

On a positive note, I recently visited the Organización Nacional de Trasplantes (ONT) in Madrid and attended the graduation ceremony of the ADVANCED INTERNATIONAL TRAINING COURSE ON TRANSPLANT COORDINATION as the guest of Dr. Rafael Matesanz

TTS and ONT have forged a relationship to help develop deceased organ donation in Central and South America.

Official Sections of The Transplantation Society