All countries should take steps to govern organ donation and transplantation, thereby ensuring patient safety and prohibiting unethical practices, according to an article appearing in the September 2008 issue of the Clinical Journal of the American Society of Nephrology (CJASN).

The document is a consensus of more than 150 representatives of scientific and medical bodies from around the world, government officials, social scientists, and ethicists, who met in Istanbul, Turkey, this spring.

Unethical practices related to transplantation include organ trafficking (the illicit sale of human organs), transplant commercialism (when an organ is treated as a commodity), and transplant tourism (when organs given to patients from outside a country undermine the country's ability to provide organs for its own population). The Declaration of Istanbul states that because unethical practices are an undesirable consequence of the global shortage of organs for transplantation, each country should implement programs to prevent organ failure and should provide organs to meet the transplant needs of its residents from donors within its own population. The therapeutic potential of deceased organ donation should also be maximized.

In an introduction to the Declaration, Dr. Francis Delmonico, professor of surgery at Harvard Medical School, emeritus professor of renal transplantation at the Massachusetts General Hospital in Boston, and the Director of Medical Affairs at The Transplantation Society (TTS), noted that with the increasing use of the Internet and the willingness of patients in rich countries to travel and purchase organs, organ trafficking and transplant tourism have become global problems. Through these practices, which target vulnerable populations in resource-poor countries, "the poor who sell their organs are being exploited, whether by richer people within their own countries or by transplant tourists from abroad," he wrote. Dr. Delmonico added that transplant tourists also risk physical harm by unregulated and illegal transplantation.

Participants in the Istanbul Summit urge transplant professionals to put an end to these activities and to foster safe and ethical practices for both transplant recipients and donors. The Declaration outlines a number of steps that can help increase deceased organ donation and ensure the protection and safety of living donors. It will be submitted to professional organizations and to the health authorities of all countries for consideration. "The legacy of transplantation must not be the impoverished victims of organ trafficking and transplant tourism but rather a celebration of the gift of health by one individual to another," the Declaration states.

The American Society of Nephrology (ASN) endorses The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. ASN stands with The Transplantation Society, the International Society of Nephrology, and other organizations in condemning these practices.

The article, entitled "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism," is in the September 2008 print issue of CJASN.