Journal Logo

In View: Special Article

Call for an End to Unethical Transplant Practices: A Concerted Effort by the Transplant Community

Haberal, Mehmet1; Cantarovich, Marcelo1; Muller, Elmi1; Fung, John J.1; Sarwal, Minnie1; Tullius, Stefan G.1; Ascher, Nancy1

Author Information
doi: 10.1097/TP.0000000000002607
  • Free

Organ transplantation has become the treatment of choice for end-stage organ disease, and as outcomes of transplantation have improved, the number of patients with end-stage organ failure listed for transplantation has increased dramatically over the years. As a result, organ shortage has become one of the greatest challenges facing the field of organ transplantation today. The unmet need for transplants has resulted in many systematic approaches to increase donor rates,1 but there have also been practices that have crossed the boundaries of legal and ethical acceptability.

The Transplantation Society has worked diligently to curtail “transplant tourism” and “organ trafficking” globally. Among our primary concerns have been meeting the growing demand for organs through ethical living and deceased organ donation by encouraging the establishment and enhancement of such programs throughout the world, promoting scientific understanding and equality in standards of clinical practice and patient care, transparency in transplantation activities, and of course educational programs to address the needs of transplant programs everywhere in the world.2-4

Each country has a responsibility to assess the transplantation needs of its own people, and the goal that we must strive for is the establishment of self-sufficiency regarding organ donation and procurement. Many countries have already achieved high rates of “deceased organ donation,” and they set a fine example to other countries where deceased donation rates are very low or, as in some countries, nonexistent. However, despite these various efforts, there continue to be reports of unethical cases of organ donation and transplantation from all over the world, and it is time for the international transplant community to take a firm stance against such activities.

In light of these concerns:

  1. TTS encourages all countries to eradicate unacceptable practices, while introducing programs that strive to achieve national or regional self-sufficiency in meeting the need for organ transplants.
  2. TTS continues to devote its efforts towards developing deceased organ donation by encouraging the establishment and enhancement of such programs throughout the world.
  3. TTS requests that scientific meeting organizers ensure all data and scientific findings that are presented are consistent with ethical and legal transplant activities.
  4. TTS calls for all scientific journals to assess all submissions for possible cases of unethical transplant activity and reject those papers that do not abide by ethical principles.

Although living donation can be a safe and acceptable source of organs if performed within ethical guidelines, our aim as the transplant community should now be to work towards a system of meeting the organ demand as much as possible with deceased donation. This will not only result in the reduction of unethical transplantation activities, but will also make an enormous difference to those patients awaiting transplants in which living organ donors are not an option.


1. Tullius SG, Rabb H. Improving the supply and quality of deceased-donor organs for transplantation. N Engl J Med. 2018;378(20):1920–1929.
2. The Madrid resolution on organ donation and transplantation: national responsibility in meeting the needs of patients, guided by the WHO principles. Transplantation. 2011;91(Suppl 11):S29–S31.
3. World Health Organization. WHO guiding principles on human cell, tissue and organ transplantation. Transplantation. 2010;90(3):229–233.
4. The Declaration of Istanbul on organ trafficking and transplant tourism. Participants in the International Summit on Transplant Tourism and Organ Trafficking Convened by the Transplantation Society and International Society of Nephrology in Istanbul, Turkey, April 30-May 2, 2008. Transplantation. 2008;86(8):1013–1018.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.