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If you required an organ transplant



      Putting a stop to organ trafficking and tourism
I f  you  required  an  organ  transplant 
and a donor was not currently available, 
                                                      Asia,  as  well  as  some  from  Europe  and 
                                                      North America (2).
                                                                                                                     ceutical companies, and funding bodies. 
                                                                                                                     Sayegh stressed that much of the work 
would  you  be  willing  to  buy  the  organ            Organ vendors mainly come from vul-                          that  has  been  going  on  in  the  months 
you needed? That was the question that                nerable populations, and particularly from                     since the Declaration was finalized has 
Mohamed  Sayegh  (Figure  1),  director               impoverished populations in developing                         been  to  ensure  that  there  is  a  defined 
of the Transplantation Research Center	               countries such as Pakistan, the Philippines,                   strategy to implement it.
at  Harvard  Medical  School,  posed  in  a           and Colombia. Sayegh said that in draft-                         As  part  of  the  way  forward,  Sayegh 
session  entitled  “No  to  organ  traffick-          ing the Declaration of Istanbul, members                       said that the steering committee is in the 
ing and tourism: an in-depth discussion               of the steering committee had paid utmost                      process  of  forming  a  Custodian  Group 
regarding the Declaration of Istanbul” at             attention to the concerns and issues raised                    that will oversee the implementation of 
Renal Week 2008, the American Society of              by representatives from the countries most                     the  Declaration.  There  are  also  a  num-
Nephrology Annual Meeting.                            affected  by  the  problem.  Ultimately,  the                  ber of task forces being convened, which 
  Although no one in the room answered                Declaration was agreed upon by consensus                       will communicate with medical societies, 
in  the  affirmative,  all  four  members  of         among the 150 participants in the summit                       pharmaceutical  companies,  and  fund-
the  discussion  panel  —  physician-scien-                                                                          ing bodies to develop rules by which each 
tists based in the United States and Can-                                                                            entity should abide and to determine the 
ada — said that they see patients who have                                                                           consequences of not adhering to the rules. 
traveled  abroad  to  be  transplanted  with                                                                         The goal is to ensure that those involved 
kidneys that they have purchased. All the                                                                            in organ trafficking are no longer accepted 
panel  members  agreed  that  they  would                                                                            by their respective communities and will 
now be very vocal in telling patients that                                                                           therefore find it much harder to continue 
this is not something they should consid-                                                                            the practice. Sayegh also noted that the 
er. However, they all admitted that before                                                                           Custodian  Group  is  hoping  to  connect 
they got involved with the Declaration of                                                                            with journals to further develop ethical 
Istanbul, this might not have been the case.                                                                         policies that have the same effect.
As Sayegh put it, before he learned more                                                                               Other  task  forces  have  already  been 
about the subject and became a member                                                                                deployed  to  talk  to  government  agen-
of the Steering Committee of the Istanbul                                                                            cies in areas that are known hotspots for 
Summit, he had always thought, so what?                                                                              organ  trafficking  and  transplant  tour-
The recipient gets a kidney and the donor                                                                            ism. Sayegh said that through the strong 
gets much-needed money.                                                                                              local networks that are being built, they 
  The Declaration of Istanbul on Organ                                                                               have received feedback about the activities 
                                                      Figure 1
Trafficking and Transplant Tourism (1)                                                                               going on in these regions, and that in some 
                                                      Mohamed Sayegh is a member of the steer-
is the result of a summit in Istanbul con-            ing committee that drafted the Declaration                     instances  the  individuals  involved  have 
vened by The Transplantation Society and              of Istanbul on Organ Trafficking and Trans-                    been sanctioned by the medical societies 
the International Society of Nephrology               plant Tourism.                                                 to which they belong.
to  discuss  organ  trafficking,  transplant                                                                           Despite the achievements so far, Sayegh 
tourism, and transplant commercialism.                                                                               was keen to point out to the JCI that the 
Although organ transplantation has pro-               —  individuals  (physicians  and  scientists,                  Declaration  of  Istanbul  is  not  going  to 
longed  and  improved  the  lives  of  many           representatives of governmental and social                     make organ trafficking disappear. He lik-
people throughout the world, there is a               agencies, social scientists, legal scholars,                   ened  it  to  drug  trafficking,  saying  that 
widespread shortage of donors, which is               and ethicists) from all but one of the 79                      because money is involved it is impossible 
one of the main factors that has led to the           countries that perform kidney transplants.                     to eradicate. However, he promised that the 
global problems of organ trafficking and                Key  to  the  Declaration  are  its  defini-                 Custodian Group will do everything it pos-
transplant  tourism.  The  WHO  has  esti-            tions of the activities it seeks to combat:                    sibly can to curb the practice and make life 
mated that approximately 10% of organ                 organ trafficking, transplant commercial-                      hard for those involved.
transplants  performed  throughout  the               ism, and transplant tourism (1). However, 
world  involve  these  practices.  However,           Sayegh told the JCI that the most impor-                       Karen Honey
this percentage is much higher in many                tant issues raised in the Declaration are                        1. Steering Committee of the Istanbul Summit. 2008. 
developing countries: one study indicates             those that address how to implement it,                             Organ  trafficking  and  transplant  tourism  and 
that by 2006, two-thirds of the 2,000 kid-            and  that  central  to  implementation  is                          commercialism: the Declaration of Istanbul. Lancet. 
ney  transplants  performed  in  Pakistan             communication  with  the  many  groups                              372:5–6.
                                                                                                                       2. Naqvi, S.A., Ali, B., Mazhar, F., Zafar, M.N., and 
were for foreign recipients, most of whom             involved, including physicians, medical                             Rizvi, S.A. 2007. A socioeconomic survey of kidney 
came  from  the  Middle  East  and  South             societies, government agencies, pharma-                             vendors in Pakistan. Transpl. Int. 20:934–939.

	                             The	Journal	of	Clinical	Investigation      Volume 119      Number 3      March 2009                                425

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