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

Capron, Alexander Morgan LLB; Delmonico, Francis L. MD; Dominguez-Gil, Beatriz MD; Martin, Dominique Elizabeth MBBS, PhD; Danovitch, Gabriel M. MD; Chapman, Jeremy MB, BChir, MD

doi: 10.1097/TP.0000000000001198
Special Article

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.

The Declaration of Istanbul group have considered the impacts of paying donor families to attain consent for organ donation. Some nations regard payments as normal and others outlaw it–the latter receive more organ donations, questioning not only the ethics but the utility of the practice.

1 Pacific Center for Health Policy and Ethics, University of Southern California, Los Angeles, CA.

2 Harvard Medical School, Massachusetts General Hospital, Boston, MA.

3 New England Organ Bank, Boston, MA.

4 Organización Nacional de Trasplantes (ONT), Madrid, Spain.

5 Health Ethics and Professionalism, Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia.

6 Kidney & Pancreas Transplant Program, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.

7 Division of Medicine and Cancer, Westmead Hospital, Sydney, NSW, Australia.

Received 8 November 2015. Revision requested 21 December 2015.

Accepted 16 January 2016.

Statement of the Declaration of Istanbul Custodian Group Regarding Payments to Families of Deceased Organ Donors: Approved by the Declaration of Istanbul Custodian Group Board of Councilors, 6 November 2015.

Disclosure: As a co-author, J.C. did not participate in any fashion in the editorial review process or the decision to publish this article.

Correspondence: Alexander M. Capron, Gould School of Law, University of Southern California, 699 Exposition Blvd., Los Angeles, CA 90089-0071. (

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