title: Statement of the Declaration of Istanbul Custodian Group Regarding Payments to Families of Deceased Organ Donors.
abstract: 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.
authors.affiliation: 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.
authors.forename: Alexander Morgan
authors.initials: AM
authors.lastname: Capron
authors.forename: Francis L
authors.initials: FL
authors.lastname: Delmonico
authors.forename: Beatriz
authors.initials: B
authors.lastname: Dominguez-Gil
authors.forename: Dominique Elizabeth
authors.initials: DE
authors.lastname: Martin
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Danovitch
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chapman
mesh_terms: D002423:Cause of Death; D035881:Compensation and Redress / Q000941:ethics; D016265:Conflict of Interest / Q000191:economics*; D005190:Family; D006801:Humans; D009042:Motivation; D011639:Public Opinion; D014019:Tissue Donors / Q000941:ethics; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000941:ethics