II. International Standards Established by Organizations for Organ and Tissue Transplantation

Since the transplant of organs from living or deceased donors to patients suffering from organ failure first began, international medical organizations and agencies have been careful to issue resolutions prescribing guidelines for the regulation of professional standards and ethics in this field. They have consistently issued recommendations to regulate practices that violate these principles.

The WHO has condemned organ trafficking on more than one occasion, starting with World Health Assembly (WHA) Resolution 40.13 in 1987. It also drew attention to the failure of efforts to combat trafficking and called on countries to compound their efforts in Resolution 42.5/1989. Resolution 44.25/1991 adopted the first draft of the WHO’s guidelines for the transplant of human organs and tissues, which established the standard procedural and ethical framework for these operations. WHA Resolution 44.25 stipulated the need to ban the sale of human organs for the purpose of transplantation.

One of the most significant recommendations issued by the WHA was in its 57th session (Resolution 57.18) in May 2004, in which the organization urged member states to exercise effective supervision on organ transplants and seek out living as well as deceased organ donors.  It also urged member states to “take measures to protect the poorest and most vulnerable groups from ‘transplant tourism’...”

In 2008, the WHO guidelines on organ and tissue transplantation were revised and adopted by the group’s executive council in the meeting held in November 2008. The guidelines recommended acquiring legal consent for the extraction of cells, tissue or organs from corpses and allowed donations from the living as long as professionals provide the necessary care to the donor and quality follow-up. Moreover, the donors should be legally competent and able to weigh the information effectively. Finally, they should be motivated by a real desire to donate their organs, without any coercion. The guidelines stress the need for a genetic, legal or emotional relationship between living donors and recipients.  Also, the donation should be accepted knowingly and voluntarily. Minors and incapacitated adults must be protected from donating under duress, and the donation must be made without promise of payment or any other material reward. However, donors may be compensated for reasonable costs incurred, including the loss of income.

The guidelines state that doctors involved in determining death cannot be involved directly or indirectly in organ transplant, extraction or exchange in any shape or form. In addition, they prohibit doctors, medical professionals and insurance companies from involvement in transplant procedures if the organ was obtained by exploiting the donor or the relative of a deceased donor, via coercion or payment. In transplant operations, all safety and quality standards must be observed. Furthermore, donation and transplantation systems must be clear and they must protect the privacy of individuals involved in the process.

Recently, more than 150 representatives of medical organizations and governments, as well as sociologists and legal researchers from 78 states and 20 international organizations met for a summit in Istanbul. The meeting concluded with the Istanbul Declaration of 2 May 2008. The summit was organized by two international organizations active in the field, the International Transplantation Society and the International Society of Nephrology. The recommendations contained in the Istanbul Declaration¹¹ added significant aspects to the system of international standards. The declaration stressed that human donation of organs at death should be encouraged, by governmental and non-governmental institutions. It emphasized the importance of health and psychological care for living donors, as well as the need to regard their actions as a heroic, life-giving feat. It also stressed the need for living donors to undergo medical and psychological evaluations before and after donation in accordance with international guidelines.

The declaration referred to the importance of non-discrimination in organ transplant procedures with regards to gender, ethnicity, religion or financial status in order to achieve the values of justice and equity. The document also provided a definition of organ trafficking,¹² noting that the traffic in organs and transplant tourism violate the principles of equity, justice and respect for human dignity.

The declaration noted that the cost of organ transplantation should not include any payment for the organ, tissue or cells used.  Moreover, costs should be calculated to incorporate legitimate expenses as part of the treatment of organ recipients.

The declaration considers the establishment of an efficient health system a strategic goal in order to prevent the spread of organ failure, which leads to an increased demand for organs.  In addition, it stressed the importance of comprehensive insurance systems that can bear the costs of transplantation operations without out-of-pocket payment requirements, which opens the door to organ trafficking. The declaration also stressed the significance of supporting education and raising awareness programs for health sector workers and citizens. Furthermore, the document also noted the importance of joint regional action to prepare a registry of donors and potential recipients without undermining the national interest of any country.

---

11- To see the document.
 

12- The declaration defines organ trafficking as “the recruitment, transport, transfer, harboring or receipt of living or deceased persons or their organs by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability, or of the giving to, or the receiving by, a third party of payments or benefits to achieve the transfer of control over the potential donor, for the purpose of exploitation by the removal of organs for transplantation.”