Obtaining consensus regarding international transplantation continues to be difficult for pediatric centers in the United States

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    2016; Epub 31st July

    Lorts A, Ryan TD, Matheny Antommaria, AH, Lake M, & Bucuvalas J. 


    Organ transplant is life-saving and any given organ may be valuable to a multitude of potential recipients. An allocation system must be used to reconcile the difference between supply and demand, and this system must take into account the impact that accepting international patients may have on the local system. The principles for allocation must be clear, equitable, provide utility and must be monitored so as to maintain public trust. The impact of the system on metrics deemed to be critical must be measured. Finally, strategies must take into account the local culture, size of the region to be supported, the number and experience of transplant centers, and the resources of the healthcare delivery system. Our focus is on the United States, recognizing that strategies and challenges may vary across countries.

    Click here to read the complete article courtesy of Pediatric Transplantation.

    Statement of the Declaration of Istanbul Custodian Group Regarding Payments to Families of Deceased Organ Donors.


    Transplantation Journal

    AM Capron, FL Delmonico, B Domínguez-Gil, D Martin, GM Danovitch, and JR Chapman

    2016; Epub June 28


    Governmental and private programs that pay next of kin who give permission for the removal of their deceased relative's organs for transplantation exist in a number of countries. Such payments, which may be given to the relatives or paid directly for funeral expenses or hospital bills unrelated to being a donor, aim to increase the rate of donation. The Declaration of Istanbul Custodian Group-in alignment with the World Health Organization Guiding Principles and the Council of Europe Convention Against Trafficking in Human Organs-has adopted a new policy statement opposing such practices.

    Payment programs are unwise because they produce a lower rate of donations than in countries with voluntary, unpaid programs; associate deceased donation with being poor and marginal in society; undermine public trust in the determination of death; and raise doubts about fair allocation of organs. Most important, allowing families to receive money for donation from a deceased person, who is at no risk of harm, will make it impossible to sustain prohibitions on paying living donors, who are at risk.

    Payment programs are also unethical. Tying coverage for funeral expenses or healthcare costs to a family allowing organs to be procured is exploitative, not "charitable." Using payment to overcome reluctance to donate based on cultural or religious beliefs especially offends principles of liberty and dignity. Finally, while it is appropriate to make donation "financially neutral"-by reimbursing the added medical costs of evaluating and maintaining a patient as a potential donor-such reimbursement may never be conditioned on a family agreeing to donate.

    To read and download this open access article, please click here.


    Trade in kidneys is ethically intolerable

    D.E. Martin

    Indian Journal Medical Ethics

    2016; Epub May 9

    Abstract: In India, as in most countries where trade in human organs is legally prohibited, policies governing transplantation from living donors are designed to identify and exclude prospective donors who have a commercial interest in donation. The effective implementation of such policies requires resources, training and motivation on the part of health professionals responsible for organ procurement and transplantation. If professionals are unconvinced by or unfamiliar with the ethical justi cation of the relevant laws and policies, they may fail to perform a robust evaluation of prospective donors and transplant candidates, and to act on suspicions or evidence of illicit activities. I comment here on a recent paper by Aggarwal and Adhikary (2016), in which the authors imply that tolerance of illicit commercialism in living kidney donation programmes is not unreasonable, given the insuf ciency of kidneys available for transplantation. I argue that such tolerance is unethical not only because of the harmful consequences of kidney traf cking, but because professional tolerance of commercialism undermines public trust in organ procurement programmes and impairs the development of sustainable donation and transplant systems.

    Read the complete paper here, courtesy of the Indian Journal of Medical Ethics.

    Read the paper by Aggarwal and Adhikary here, courtesy of the Indian Journal of Medical Ethics.

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