Declaration of Istanbul Custodian Group

In 2010, the leaders of the parent organizations of the Declaration of Istanbul (DOI), The Transplantation Society (TTS) and The International Society of Nephrology (ISN) formed the Declaration of Istanbul Custodian Group (DICG), empowering the DICG to promote and sustain the DOI. A strategic plan of accomplishment by 2018 (the 10th Anniversary of the DOI) was developed to implement programs that could combat organ trafficking.

The DICG identified proper travel for transplantation as a topic of high priority. The DOI defines travel for transplantation as ‘the movement of organs, donors, recipients, or transplant professionals across jurisdictional borders for transplantation purposes’. The DOI further suggests that travel for transplantation becomes transplant tourism - and ethically unacceptable - if ‘it involves organ trafficking and/or transplant commercialism or if the resources (organs, professionals, and transplant centres) devoted to providing transplants to patients from outside a country undermine the country’s ability to provide transplant services for its own population’.

Under this general framework, the DICG identified a lack of guidelines for professionals in their care of transplant tourists, either prospectively – before the departure to a foreign country for transplantation purposes – or upon their return to their home country. There was a similar lack in relation to governments’ need of common policy and coordinated approaches in this field. The DICG convened a working group to address these challenges and develop procedural guidelines for both professionals and ministries of health contending with transplant tourists in the context of proper care – that otherwise can be accomplished by ethical travel for transplantation. In April of this year, a workshop took place in Madrid (Spain) with participants consisting of members of DICG Council and other individuals well known to the topic of proper travel for transplantation. The meeting was jointly sponsored by the ISN and TTS.

The workshop addressed travel for transplantation from two complementary perspectives:

  • A Prospective Review Process of proper travel for transplantation when a patient indicates the intent to travel to a foreign destination for organ transplantation.
  • A Retrospective Process to consider when a patient returns to their native country for medical care after they received a transplant in a foreign destination.

The DICG is in the midst of the preparation of the concrete and highly needed procedural guidelines and recommendations arising from this event.