An increasing number of patients worldwide are in need of an organ for transplantation. Organ
transplantation from deceased donors should be fostered by the recovery of organs after the
determination of either brain death or cardiac death. However, The Transplantation Society
recognizes that the burden and opportunity for successful organ transplantation is now regularly
placed upon the willingness of a live and well human being to provide a kidney or a portion of
the liver for transplant recipients with end stage organ failure. Live organ transplantation now
also includes the transplantation of a lobe of the lung, and a portion of the pancreas or intestine.
The widespread acceptance of live organ transplantation is clearly counter to what historically has
been a medical dictum to do no harm. Because of the emerging hazard for some individuals who are
medically well and volunteer to donate an organ for transplantation, forums in Amsterdam and Vancouver
were developed by The Transplantation Society to present definitive and timely statements regarding the
responsibility of the transplant community to care for the live organ donor (1, 2). The ethics of a
continuing practice of live organ transplantation demands an international recognition that prioritizes
a sustained well being of the donor despite the life saving transplant that may be provided by the donor
for the recipient (3, 4). The person who gives consent to be a live organ donor should be competent,
willing to donate, free of coercion, medically and psychosocially suitable, fully informed of the risks
and benefits as a donor, and fully informed of risks, benefits, and alternative treatment available
to the recipient (5).
The Council of The Transplantation Society first addressed commercialization or brokerage of transplantable
organs more than 20 years ago to declare its opposition (6). If the organ donation process were to be
relegated to the laws of the market place, the less privileged might be exploited to improve the health
of the more privileged, and the established safeguards surrounding altruistic donation would be compromised.
Thus, guidelines were developed by the Council of The Transplantation Society that has been sustained to date:
"No transplant surgeon/team shall be involved directly or indirectly in the buying or selling of organs/tissues.”
This position is reiterated in the current policy statement provided to member applicants, namely that: "organs
and tissues should be freely given without commercial consideration or financial profit."
Transplant tourism is a recently described phenomenon that may entail exploitive practices of organ
transplantation for recipients who travel outside their country of residence to purchase an organ from a
vendor. A practice of transplant tourism that has no transparency or professional oversight violates ethical
principles of care. The Transplantation Society is opposed to practices of transplant tourism that exploit
donors and recipients.
The Transplantation Society is opposed to the recovery of organs from executed prisoners. It is a fundamental
principle for The Transplantation Society that organs and tissues are given freely and without coercion. Because
of the restrictions in liberty in a prison environment it is unlikely that prisoners are truly free to make
independent decisions and thus an autonomous informed consent for donation cannot be obtained. Further, the
financial incentive for recovering organs from executed prisoners may become an incentive to increase the number
of such organs available for transplantation.
Scientific and clinical studies of human transplantation should be conducted with Institutional Review Board
approval and adhere to the Helsinki Declaration of the World Medical Association: Ethical Principles For Medical
Research Involving Human Subjects (7).
Scientific and clinical studies of xenotransplantation should adhere to the ethical principles set forth by the
International Xenotransplant Association (8).
TTS Amsterdam Forum on the Care of the Live Kidney Donor: Data and Medical Guidelines.
(PDF Format, opens in new window)
TTS Vancouver Forum on the care of the live organ donor: lung, liver, pancreas, and intestine data and medical guidelines
(PDF Format, opens in new window)
References
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A Report of the Amsterdam Forum on the Care of the Live Kidney Donor: Data and Medical Guidelines. Transplantation. 2005 Mar 27; 79 (6):S53-S66.
Click here to view full document
(PDF Format, opens in new window)
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Barr ML, Belghiti J, Villamil FG, Pomfret EA, Sutherland DS, Gruessner RW, Langnas AN,
Delmonico FL. A report of the Vancouver Forum on the care of the live organ donor: lung,
liver, pancreas, and intestine data and medical guidelines. Transplantation. 2006 May 27; 81 (10):1373-85.
Click here to view full document
(PDF Format, opens in new window)
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The Consensus Statement of the Amsterdam Forum on the Care of the Live Kidney Donor. Transplantation 2004.Aug 27; 78 (4) 491-492.
Click here to view full document
(PDF Format, opens in new window)
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Pruett TL, Tibell A, Alabdulkareem A, Bhandari M, Cronin DC, Dew MA, Dib-Kuri A, Gutmann T, Matas A, McMurdo L,
Rahmel A, Rizvi SA, Wright L, Delmonico FL. The Ethics Statement of the Vancouver Forum on the Live Lung, Liver,
Pancreas, and Intestine Donor. Transplantation. 2006 May 27; 81(10): 1386-1387.
Click here to view full document
(PDF Format, opens in new window)
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Consensus Statement on the Live Organ Donor. JAMA. 2000; 284:2919-2926.
Click here to view full document
(PDF Format, opens in new window)
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Council of The Transplantation Society: Commercialization in transplantation: the problems and some guidelines
for practice. Lancet. 1985 Sep 28; 2(8457):715-6; Transplantation. 1986 Jan;41(1):1-3.
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http://ohsr.od.nih.gov/guidelines/helsinki.html
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Sykes M, d'Apice A, Sandrin M; IXA Ethics Committee. Position paper of the Ethics Committee of the International
Xenotransplantation Association. Transplantation. 2004 Oct 27; 78(8):1101-7.
Click here to view full document
(PDF Format, opens in new window)
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