Statement of the Declaration of Istanbul Custodian Group regarding payments to families of deceased organ donors

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.

Sarah Bernhardt

Sarah Bernhardt (born Sara-Marie-Henriette Bernard, 1844-1923) is the most famous French actress of the late nineteenth century. Celebrated for her golden voice and for the sinuous flow of her slender figure on stage, she was also a theatre manager, author, sculptor, painter, and a clever businesswoman. She developed and nurtured global fame in an era when the popular press facilitated international renown. Print media as well as the emerging phonograph and film industries enabled Bernhardt to cultivate and develop her celebrity into the early twentieth century, appealing to new publics and audiences. During the First World War she became a French porte-parole for the Allied cause, appearing on stage and in a propaganda film, as well as in demonstrations and events in support of Allied troops across France and America. When Bernhardt died in 1923 at the age of 78, millions crowded the streets to watch her funeral cortège pass through Paris. This essay explores her achievements in her lifetime.