Organ trafficking and transplant tourism: the role of global professional ethical standards - the 2008 declaration of Istanbul

By 2005, human organ trafficking, commercialization, and transplant tourism had become a prominent and pervasiveinfluence on transplantation therapy. The most common source of organs was impoverished people in India,Pakistan, Egypt, and the Philippines, deceased organ donors in Colombia, and executed prisoners in China. Inresponse, in May 2008, The Transplantation Society and the International Society of Nephrology developed theDeclaration of Istanbul on Organ Trafficking and Transplant Tourism consisting of a preamble, a set of principles, anda series of proposals. Promulgation of the Declaration of Istanbul and the formation of the Declaration of IstanbulCustodian Group to promote and uphold its principles have demonstrated that concerted, strategic, collaborative,and persistent actions by professionals can deliver tangible changes. Over the past 5 years, the Declaration of IstanbulCustodian Group organized and encouraged cooperation among professional bodies and relevant international, regional,and national governmental organizations, which has produced significant progress in combating organ traffickingand transplant tourism around the world. At a fifth anniversary meeting in Qatar in April 2013, the DICGtook note of this progress and set forth in a Communique´ a number of specific activities and resolved to furtherengage groups from many sectors in working toward the Declaration’s objectives.

Caution: deceased donor organ commercialism!

In the past 3 years there have been attempts to counter the international campaignagainst a market in organs from the living. In parallel to these attempts,support for a market in organs from the deceased has gained some traction. Inthis article we describe the various forms of this phenomenon, analyze itsimplications, and call upon policy makers to take steps to halt its progress.

The long road from the kidney bazaar: a commentary on Pakistan’s progress towards self-sufficiency in organ transplantation

The dark history of transplant tourism in Pakistan demonstrates the hazards of unregulated cross-border markets in human organs. Trading on existing national and international social inequities, ‘transplant tourism’ offers dubious benefits for transplant recipients and attractive profits to those facilitating the industry at the expense of the world’s poor. The impact of Pakistan’s 2007 Transplantation of Human Organs and Tissue Ordinance and the sustained efforts of transplant professionals and societal groups led by the Sindh Institute of Urology and Transplantation, show that organ trading can be effectively discouraged and equitable programs of organ procurement and transplantation pursued despite multiple challenges. In this paper, the factors that have contributed to Pakistan’s progress towards self-sufficiency in organ transplantation are identified and discussed. The case of Pakistan highlights the need for countries to protect their own organ and tissue providers who may be vulnerable in the global healthcare market. Pakistan provides an excellent example for other countries in the region and throughout the world to consider when regulating their own transplantation programs and considering the pursuit of national self-sufficiency.

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.

Book review : the red market : on the trail of the world’s organ brokers, bone thieves, blood farmers, and child traffickers

Book review of The Red Market: On the Trail of the World's Organ Brokers, Bone Thieves, Blood Farmers, and Child Traffickers. Scott Carney, 2011, William Morrow (New York, 978-0-06-193646-3, 272 pp.)

The evolution of the avian bill as a thermoregulatory organ.

The avian bill is a textbook example of how evolution shapes morphology in response to changing environments. Bills of seed-specialist finches in particular have been the focus of intense study demonstrating how climatic fluctuations acting on food availability drive bill size and shape. The avian bill also plays an important but under-appreciated role in body temperature regulation, and therefore in energetics. Birds are endothermic and rely on numerous mechanisms for balancing internal heat production with biophysical constraints of the environment. The bill is highly vascularised and heat exchange with the environment can vary substantially, ranging from around 2% to as high as 400% of basal heat production in certain species. This heat exchange may impact how birds respond to heat stress, substitute for evaporative water loss at elevated temperatures or environments of altered water availability, or be an energetic liability at low environmental temperatures. As a result, in numerous taxa, there is evidence for a positive association between bill size and environmental temperatures, both within and among species. Therefore, bill size is both developmentally flexible and evolutionarily adaptive in response to temperature. Understanding the evolution of variation in bill size however, requires explanations of all potential mechanisms. The purpose of this review, therefore, is to promote a greater understanding of the role of temperature on shaping bill size over spatial gradients as well as developmental, seasonal, and evolutionary timescales.