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死刑犯器官捐贈 醫院意願不高
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法務部今晚執行6名死刑犯，器官捐贈移植登錄中心董事長李伯璋表示，國內進行器官移植醫院對死刑犯器官捐贈意願不高。
法務部今晚證實，法務部長曾勇夫20日簽署死刑犯曾思儒、洪明聰、黃賢正、陳金火、廣德強與戴德穎執行令，今晚已執行完畢。 財團法人器官捐贈移植登錄中心董事長李伯璋表示，2008年國際移植醫學會(The TransplantationSociety)發布「伊斯坦堡宣言(The Declaration ofIstanbul)」，明文禁止器官買賣、器官移植旅遊及利用死刑犯的器官。 李伯璋表示，依國際伊斯坦堡宣言，國內移植器官醫師都應重視這個問題，他知道這次執行的死刑犯中北、中、南各有1名想要捐贈器官，不過從事移植器官醫院的移植團隊持保留態度，沒有很想要執行摘取器官手術的意願，這仍有許多倫理與價值觀的考量。 李伯璋表示，國內已經有許多移植醫院，包括長庚醫院、奇美醫院、成大醫院、義大醫院等態度保守，原本亞東醫院一度有意願，不過捐贈者的心臟功能不好又有B型肝炎，而沒有進行捐贈。 器官捐贈協會祕書長吳英萊表示，目前國內等待器官捐贈者約8000多人，死刑犯也是人，應該同等看待，死刑犯被槍決代表罪惡的結束，而捐贈器官是愛心的起頭，社會應該多給予互相尊重。
【2012/12/21 中央社】
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全文網址: 死刑犯器官捐贈 醫院意願不高 | 六死因行刑完畢 | 國內要聞 | 聯合新聞網 http://udn.com/NEWS/NATIONAL/NATS1/7582585.shtml#ixzz2FniSXHK4
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( 伊斯坦堡宣言 器官非法交易及移植旅遊 )
Preamble ( 序文 )
Organ transplantation, one of the medical miracles of the twentieth century, has prolonged and improved the lives of hundreds of thousands of patients worldwide. (器官移植是二十世紀醫學奇蹟之一, 已經延長並改善全世界百以千以數計的病人生命) The many great scientific and clinical advances of dedicated health professionals, as well as countless acts of generosity by organ donors and their families, have made transplantation not only a life-saving therapy but a shining symbol of human solidarity. (許多獻身於人類健康的專家偉大的科學上以至於實際臨床上的進步以及更多無法計算的器官捐贈者與家屬們慷慨無私的行為已經使得器官移植不僅僅是一個救命的治療更是一個人類團結的光輝象徵 )Yet these accomplishments have been tarnished by numerous reports of trafficking in human beings who are used as sources of organs and of patient-tourists from rich countries who travel abroad to purchase organs from poor people.(然而這些成就已經被許多把活人作為器官來源的非法交易以及安排富有國家的病人至可以從窮人身上購買器官的出國旅遊的許多報告抹黑) In 2004, the World Health Organization, called on member states “to take measures to protect the poorest and vulnerable groups from transplant tourism and the sale of tissues and organs, including attention to the wider problem of international trafficking in human tissues and organs(1). ”(在2004年, 世界衛生組織呼籲會員國希望找出方法保護最貧窮最容易受傷害的族群免於移植旅遊以及組織與器官買賣包括注意國際間人類組織與器官非法買賣這個牽扯更廣的問題)
To address the urgent and growing problems of organ sales, transplant tourism and trafficking in organ donors in the context of the global shortage of organs, a Summit Meeting of more than 150 representatives of scientific and medical bodies from around the world, government officials, social scientists, and ethicists, was held in Istanbul from April 30 to May 2, 2008. (著眼於這個急迫的蓬勃發展中的器官買賣, 移植旅遊, 以及因應全球器官短缺衍伸的非法交易器捐者的問題,超過一百五十個代表全世界科學界與醫界, 政府官員, 社會學者及倫理學家在2008年四月三十日至五月二日在伊斯坦堡舉行高峰會議 Preparatory work for the meeting was undertaken by a Steering Committee convened by The Transplantation Society (TTS) and the International Society of Nephrology (ISN) in Dubai in December 2007. ( 會議的籌備工作由移植學會以及國際腎臟學會於2007年在杜拜召集一個指導委員會) That committee’s draft declaration was widely circulated and then revised in light of the comments received. ( 委員會草擬的宣言則廣為流傳並按照接收到的意見修正) At the Summit, the revised draft was reviewed by working groups and finalized in plenary deliberations. (在這次的高峰會, 修正好的草案則被工作小組反覆討論最後在充分的集思廣益下定稿)
This Declaration represents the consensus of the Summit participants. (這個宣言代表高峰會參與者的共識 ) All countries need a legal and professional framework to govern organ donation and transplantation activities, as well as a transparent regulatory oversight system that ensures donor and recipient safety and the enforcement of standards and prohibitions on unethical practices.(所有的國家需要法律與專家的架構下去管理器官捐贈與器官移植的活動以及透明管控的監察系統來確保器捐者與受贈者的安全並強制標準程序以及禁止非倫理的醫療)
Unethical practices are, in part, an undesirable consequence of the global shortage of organs for transplantation. (非倫理的醫療有一部分是全球器官短缺不願見到的後遺症) Thus, each country should strive both to ensure that programs to prevent organ failure are implemented and to provide organs to meet the transplant needs of its residents from donors within its own population or through regional cooperation. (因此, 每一個國家應該致力於避免器官衰竭的計畫以及利用自己的人民或者區域合作提供自己國家人民器官移植所需的器官 ) The therapeutic potential of deceased organ donation should be maximized not only for kidneys but also for other organs, appropriate to the transplantation needs of each country. ( 死後捐贈器官的治療可能性應該推廣放大, 不可局限於腎臟也要包含適合各個國家移植需求的其他器官) Efforts to initiate or enhance deceased donor transplantation are essential to minimize the burden on living donors. ( 啟動或促進死後捐贈的器官移植是減少活體捐贈負擔的必要措施 ) Educational programs are useful in addressing the barriers, misconceptions and mistrust that currently impede the development of sufficient deceased donor transplantation; ( 指出目前妨礙足夠死後器捐發展的這些障礙誤解與不信任的教育計劃是有效的 ) successful transplant programs also depend on the existence of the relevant health system infrastructure. (成功的移植計畫也依賴這些有關的健康體系基礎架構的存在 )
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Access to healthcare is a human right but often not a reality. (健康照護的取得是人類權力但經常並無法實現)The provision of care for living donors before, during and after surgery–as described in the reports of the international forums organized by TTS in Amsterdam and Vancouver (2-4)–is no less essential than taking care of the transplant recipient. (提供活體捐贈者的術前術中與術後照顧絕對不會比照顧受贈者不重要, 就像移植醫學會在阿姆斯特丹與溫哥華舉辦的國際論壇中的報告描述的一般 ) A positive outcome for a recipient can never justify harm to a live donor ( 受贈者一個正向的結果也從未讓活體捐贈者受傷害這個事實變成合理 ) ; on the contrary, for a transplant with a live donor to be regarded as a success means that both the recipient and the donor have done well.( 相反的, 對活體捐贈的器官移植來說成功指的是受贈者與捐贈者同時安全沒事 )
This Declaration builds on the principles of the Universal Declaration of Human Rights (5).( 這個宣言建構在人權的普世宣言的準則中) The broad representation at the Istanbul Summit reflects the importance of international collaboration and global consensus to improve donation and transplantation practices.( 在伊斯坦堡高峰會廣大的代表反映出國際合作與全球共識來促進器官捐贈與移植醫療的重要性) The Declaration will be submitted to relevant professional organizations and to the health authorities of all countries for consideration.(這個宣言將被傳送到相關的專業機構以及所有國家的健康權威機構參考 ) The legacy of transplantation must not be the impoverished victims of organ trafficking and transplant tourism but rather a celebration of the gift of health by one individual to another. ( 器官移植的遺贈必須不能是赤貧者因器官非法買賣或者移植旅遊而受害痛苦而應該是一個人贈送給另一個人的愉悅健康禮物)
Definitions (定義 )
Organ trafficking is 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 (6). (器官非法買賣指的是招募運輸轉送藏匿接收活人或死人或僅其器官, 藉著威脅, 武力, 或任何強迫, 誘拐綁架, 詐術,蒙騙, 濫用權力或者是利用弱勢位階或給予或接受第三者金錢或利益來達到潛在捐贈者的控制權轉移來達到摘採可供器官移植器官的目的
Transplant commercialism is a policy or practice in which an organ is treated as a commodity, including by being bought or sold or used for material gain.(器官移植商業化是指將器官視為一種商品, 包括可以被買被賣或被用來獲得物資的一種政策或辦法 )
Travel for transplantation is the movement of organs, donors, recipients or transplant professionals across jurisdictional borders for transplantation purposes. ( 為了器官移植旅行指的是為了移植的目地而產生的器官或者器捐者或者受贈者或者移植專家跨越管轄權的一種移動 ) Travel for transplantation becomes transplant tourism if it involves organ trafficking and/or transplant commercialism or if the resources (organs, professionals and transplant centers) devoted to providing transplants to patients from outside a country undermine the country’s ability to provide transplant services for its own population. ( 為了器官移植而旅行會變成所謂的器官移植旅遊, 如果裡面牽涉到器官非法買賣以及或者器官移植商業化或者不管器官或者移植專家甚至整間移植中心等資源願意不管國家人民利益為非本國患者移植)
Principles 原則
1. National governments, working in collaboration with international and non-governmental organizations, should develop and implement comprehensive programs for the screening, prevention and treatment of organ failure, ( 國家政府, 國際間合作與非政府機關應發展並執行綜合的篩選避免與治療器官衰竭的完整計畫 ) which include: a. The advancement of clinical and basic science research;(那包括一, 臨床與基礎的科學研究 ) b. Effective programs, based on international guidelines, to treat and maintain patients with end-stage diseases, such as dialysis programs for renal patients, to minimize morbidity and mortality, alongside transplant programs for such diseases; (二, 有效的基於國際間準則與器官移植計畫同時並行的有效計畫來治療並維持末期器官疾病例如腎臟病人的透析來降低併發症與死亡率) c. Organ transplantation as the preferred treatment for organ failure for medically suitable recipients. ( 三, 將醫學評估合適的受贈者使用器官移植當作器官衰竭的優先治療選項 )
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2. Legislation should be developed and implemented by each country or jurisdiction to govern the recovery of organs from deceased and living donors and the practice of transplantation, consistent with international standards.( 每個國家或管轄區需立法並施行來管理不管來自死後捐贈或者活體捐贈的器官的恢復狀況以及符合國際間標準的器官移植的施行狀況 a. Policies and procedures should be developed and implemented to maximize the number of organs available for transplantation, consistent with these principles;( 一, 策略與步驟必須發展並施行推廣放大以符合這些原則可移殖器官的數量) b. The practice of donation and transplantation requires oversight and accountability by health authorities in each country to ensure transparency and safety; ( 二, 捐贈與移植的施行需要每個國家有健康權威機構來監督並承擔責任來確保透明及安全 c. Oversight requires a national or regional registry to record deceased and living donor transplants;( 監督需要一個全國的或者區域性的登錄來記錄死後捐贈以及活體捐贈) d. Key components of effective programs include public education and awareness, health professional education and training, and defined responsibilities and accountabilities for all stakeholders in the national organ donation and transplant system. ( 主要的有效計畫的組成包括大眾的教育與認識, 醫事人員的教育與訓練, 以及明確規定出所有利害關係人在全國的器官捐贈與移植體系的責任與擔當)
3. Organs for transplantation should be equitably allocated within countries or jurisdictions to suitable recipients without regard to gender, ethnicity, religion, or social or financial status.. ( 用來器官移植的器官應該平等地分配在國內或管轄區的合適受贈者, 不管性別種族宗教或社經地位) a. Financial considerations or material gain of any party must not influence the application of relevant allocation rules( 經濟上的考慮或者何方團體的物質利益都不可影響恰當的分配準則的施用 )
4. The primary objective of transplant policies and programs should be optimal short- and long-term medical care to promote the health of both donors and recipients.(器官移植政策與計畫的主要目的應該有最理想的短期與長期的醫療照護來增進器捐者以及受贈者的健康) a. Financial considerations or material gain of any party must not override primary consideration for the health and well-being of donors and recipients. ( 經濟上的考量或者任何團體的物質利益都不應該凌駕於對於器捐者與受贈者健康與福利主要考量 )
5. Jurisdictions, countries and regions should strive to achieve self-sufficiency in organ donation by providing a sufficient number of organs for residents in need from within the country or through regional cooperation.(管轄區, 國家與區域應該藉由國內或者區域合作努力達到在器官捐贈的自我充足 a. Collaboration between countries is not inconsistent with national self- sufficiency as long as the collaboration protects the vulnerable, promotes equality between donor and recipient populations, and does not violate these principles; ( 一, 國家間的合作並不違背國家自我充足的原則只要合作條件可以保障易受傷者並促使捐贈者與受贈者的平等以及不違背這裡記載的原則) b. Treatment of patients from outside the country or jurisdiction is only acceptable if it does not undermine a country’s ability to provide transplant services for its own population. (二, 治療國外或統轄權外的患者只有在不傷害本國需要器官移植的人民權利下可被接受)
6. Organ trafficking and transplant tourism violate the principles of equity, justice and respect for human dignity and should be prohibited. (器官非法交易與移植旅遊違反平等公平及尊重人類尊嚴的原則應該被禁止) Because transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice and should be prohibited.( 因為器官移植商業化鎖定赤貧與弱勢族群, 導致無情的不平等及不公正而且應該被禁止 ) In Resolution 44.25, the World Health Assembly called on countries to prevent the purchase and sale of human organs for transplantation.( 在WHA 世界衛生大會決議文44.25中呼籲各國避免購買或販售人類器官供移植之用 ) a. Prohibitions on these practices should include a ban on all types of advertising (including electronic and print media), soliciting, or brokering for the purpose of transplant commercialism, organ trafficking, or transplant tourism.( 一, 禁止這些醫療行為應包括禁止所有形式的廣告不管電子或印刷,乞求, 或代理器官移植商業化或器官非法買賣, 或器官移植旅遊的目的) b. Such prohibitions should also include penalties for acts—such as medically screening donors or organs, or transplanting organs—that aid, encourage, or use the products of, organ trafficking or transplant tourism.(二, 這些禁令應包括處罰會變相幫助, 鼓勵或使用器官, 非法買賣或器官移植旅遊例如醫學上篩選捐贈者或器官以及移植器官等行為), c. Practices that induce vulnerable individuals or groups (such as illiterate and impoverished persons, undocumented immigrants, prisoners, and political or economic refugees) to become living donors are incompatible with the aim of combating organ trafficking, transplant tourism and transplant commercialism.( 三, 許多作為或陋習導致弱勢個人或團體例如文盲或窮人, 無正式文件的移民, 犯人, 政治或經濟難民等變成活體捐贈者跟打擊非法器官買賣, 器官捐贈旅遊及器官捐贈商業化的目標是矛盾的
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Proposals Consistent with these principles, participants in the Istanbul Summit suggest the following strategies to increase the donor pool and to prevent organ trafficking, transplant commercialism and transplant tourism and to encourage legitimate, life-saving transplantation programs:(符合這些原則的提議案, 伊斯坦堡高峰會的參與者建議底下的策略來增加組織庫並避免器官非法買賣, 器官移植商業化以及器官移植旅遊來鼓勵合法的拯救生命的器官移植計畫
To respond to the need to increase deceased donation: ( 來反應死後捐贈的需求的增加 )
1. Governments, in collaboration with health care institutions, professionals, and non- governmental organizations should take appropriate actions to increase deceased organ donation.(一, 政府配合健康照護機構及專家及非政府組織應該採取適當的作為來增加死後器官捐贈) Measures should be taken to remove obstacles and disincentives to deceased organ donation.( 拿出方法來移除死後器官捐贈的障礙與抑制因素) ( 2. In countries without established deceased organ donation or transplantation, national legislation should be enacted that would initiate deceased organ donation and create transplantation infrastructure, so as to fulfill each country’s deceased donor potential.(二, 在尚未建立死後器官捐贈或移植的國家, 國家立法應該制定啟用死後捐贈器官以及建立移植基礎建設來滿足每個國家死後捐贈的潛在需要) 3. In all countries in which deceased organ donation has been initiated, the therapeutic potential of deceased organ donation and transplantation should be maximized.(三, 在所有死後器官捐贈已經啟用國家, 死後捐贈器官與移植的可能治療潛能應該盡量放大推廣) 4. Countries with well established deceased donor transplant programs are encouraged to share information, expertise and technology with countries seeking to improve their organ donation efforts.( 四, 已經建立非常好的死後器官捐贈計畫的國家被鼓勵分享資訊與專業還有技術給那些還在尋求改善他們的器官捐贈的事務)
To ensure the protection and safety of living donors and appropriate recognition for their heroic act while combating transplant tourism, organ trafficking and transplant commercialism: ( 為了確保活體捐贈者的安全並適當的表彰他們的英雄行為來對抗器官移植旅遊, 器官非法買賣以及器官移植商業化 )
1. The act of donation should be regarded as heroic and honored as such by representatives of the government and civil society organizations. ( 一, 捐贈的行為應被視為英雄式並且被表揚, 視為政府或人民團體機構的代表 )
2. The determination of the medical and psychosocial suitability of the living donor should be guided by the recommendations of the Amsterdam and Vancouver Forums (2-4).( 決定活體捐贈者醫學上或精神社交上的合適度應該參考阿姆斯特丹與溫哥華論壇的建議( 2-4) a. Mechanisms for informed consent should incorporate provisions for evaluating the donor’s understanding, including assessment of the psychological impact of the process; ( 告知同意書的辦法應加上提供評估捐贈者的了解程度包括估計整個過程精神上的衝擊) b. All donors should undergo psychosocial evaluation by mental health professionals during screening. ( 全部的捐贈者應該在篩選時接受精神健康專家精神與社交評估 )
3. The care of organ donors, including those who have been victims of organ trafficking, transplant commercialism, and transplant tourism, is a critical responsibility of all jurisdictions that sanctioned organ transplants utilizing such practices. ( 照護器官捐贈者包括那些已經是器官非法買賣器官移植商業化以及器官移植旅遊的受害者是所有批准使用這類器官移植醫療行為的管轄區非常重要的責任)
4. Systems and structures should ensure standardization, transparency and accountability of support for donation. a. Mechanisms for transparency of process and follow-up should be established; b. Informed consent should be obtained both for donation and for follow-up processes. ( 體系與機構應該確定標準化透明化以及承擔支持器捐的責任 一, 處理流程的透明化及追蹤的機制應該建立 二, 告知同意書應該同時兼顧捐贈與日後追蹤的流程 )
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5. Provision of care includes medical and psychosocial care at the time of donation and for any short- and long-term consequences related to organ donation. ( 提供的照顧應該包括醫學上的與精神社交上的的照顧, 不管是捐贈的時候或者任何短期或長期跟捐贈有關的後遺症) a. In jurisdictions and countries that lack universal health insurance, the provision of disability, life, and health insurance related to the donation event is a necessary requirement in providing care for the donor; ( 一, 在缺乏廣泛的健康保險的國家或管轄區,提供捐贈者跟捐贈有關的殘障供養, 生活與健康保證是必要的 ) b. In those jurisdictions that have universal health insurance, governmental services should ensure donors have access to appropriate medical care related to the donation event;( 二, 在有廣泛健康保險的管轄區, 政府服務須確保器捐者器捐相關的醫療照護的可近性 ) c. Health and/or life insurance coverage and employment opportunities of persons who donate organs should not be compromised; ( 三, 對於器捐者的健康或生活保險的保障以及聘僱機會不應受影響) d. All donors should be offered psychosocial services as a standard component of follow-up; ( 四, 所有的器捐者應該提供精神與社交上的服務當作是追蹤的一種標準部分) e. In the event of organ failure in the donor, the donor should receive: ( ; i. Supportive medical care, including dialysis for those with renal failure, and ii. Priority for access to transplantation, integrated into existing allocation rules as they apply to either living or deceased organ transplantation.( 五,萬一器捐者出現器官衰竭, 器捐者應該接受支持性的醫學照護, 包括那些腎臟衰竭病人的透析治療而且對於需要器官移植的優先權不管是活體或者死後捐贈器官應該加入現行的分配原則中)
6. Comprehensive reimbursement of the actual, documented costs of donating an organ does not constitute a payment for an organ, but is rather part of the legitimate costs of treating the recipient. ( 總結的保險理賠對於器捐實際上的有文件的花費不該是指定是某個器官的給付 而是治療受贈者合法的費用的一部份) a. Such cost-reimbursement would usually be made by the party responsible for the costs of treating the transplant recipient (such as a government health department or a health insurer); ( 一, 這個花費理賠經常是負責器官移植受贈者治療的一方負責, 比如說政府健康部門或者健康保險業者 )
b. Relevant costs and expenses should be calculated and administered using transparent methodology, consistent with national norms;( 二, 相關的成本與支出應該使用透明的符合國家基準的方法來計算與使用 ) c. Reimbursement of approved costs should be made directly to the party supplying the service (such as to the hospital that provided the donor’s medical care);( 三, 被驗證過的花費理賠應該直接付給提供服務的一方例如提供捐贈者醫療照護的醫院) d. Reimbursement of the donor’s lost income and out-of-pockets expenses should be administered by the agency handling the transplant rather than paid directly from the recipient to the donor. ( 四, 對於器捐者收入以及非預期支出損失的理賠, 應該由處理移植事務的代辦機構給予而不要直接讓受贈者付給捐贈者)
7. Legitimate expenses that may be reimbursed when documented include: a. the cost of any medical and psychological evaluations of potential living donors who are excluded from donation (e.g., because of medical or immunologic issues discovered during the evaluation process); ( 合法的支出可能可以被理賠的應該文件化, 包括一, 任何一位可能活體捐贈者的醫療與精神評估的花費即使後來被認為不適合捐贈)b. costs incurred in arranging and effecting the pre-, peri- and post-operative phases of the donation process (e.g., long-distance telephone calls, travel, accommodation and subsistence expenses); (二,因為安排及達成器捐術前術中術後捐贈過程目的導致的花費)c. medical expenses incurred for post-discharge care of the donor(三, 器捐者出院後照護產生的醫療支出); d. lost income in relation to donation (consistent with national norms). ( 符合國家基準的跟器捐相關的收入損失 )
References
1. World Health Assembly Resolution 57.18, Human organ and tissue transplantation, 22 May 2004, http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_R18-en.pdf.
2. The Ethics Committee of the Transplantation Society (2004). The Consensus Statement of the Amsterdam Forum on the Care of the Live Kidney Donor. Transplantation 78(4):491-92.
3. Barr ML, Belghiti J, Villamil FG, Pomfret EA, Sutherland DS, Gruessner RW, Langnas AN & Delmonico FL (2006). A Report of the Vancouver Forum on the Care of the Life Organ Donor: Lung, Liver, Pancreas, and Intenstine Data and Medical Guidelines. Transplantation 81(10):1373-85.
4. Pruett TL, Tibell A, Alabdulkareem A, Bhandari M, Cronon DC, Dew MA, Dib-Kuri A, Gutmann T, Matas A, McMurdo L, Rahmel A, Rizvi SAH, Wright L & Delmonico FL (2006). The Ethics Statement of the Vancouver Forum on the Live Lung, Liver, Pancreas, and Intestine Donor. Transplantation 81(10):1386-87.
5. Universal Declaration of Human Rights, adopted by the UN General Assembly on December 10, 1948, http://www.un.org/Overview/rights.html.
6. Based on Article 3a of the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, Supplementing the United Nations Convention Against Transnational Organized Crime, http://www.uncjin.org/Documents/Conventions/dcatoc/final_ documents_2/convention_%20traff_eng.pdf.
* The Participants in the International Summit on Transplant Tourism and Organ Trafficking and the manner in which they were chosen and the meeting was organized were as follows:
Process and Participant Selection
Steering Committee:
The Steering Committee was selected by an Organizing Committee consisting of Mona Alrukhami, Jeremy Chapman, Francis Delmonico, Mohamed Sayegh, Faissal Shaheen, and Annika Tibell.
The Steering Committee was composed of leadership from The Transplantation Society, including its President-elect and the Chair of its Ethics Committee, and the International Society of Nephrology, including its Vice President and individuals holding Council positions. The Steering Committee had representation from each of the continental regions of the globe with transplantation programs.
The mission of the Steering Committee was to draft a Declaration for consideration by a diverse group of participants at the Istanbul Summit. The Steering Committee also had the responsibility to develop the list of participants to be invited to the Summit meeting.
Istanbul Participant Selection:
Participants at the Istanbul Summit were selected by the Steering Committee according to the following considerations:
• The country liaisons of The Transplantation Society representing virtually all countries with transplantation programs;
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• Representatives from international societies and the Vatican; • Individuals holding leadership positions in nephrology and transplantation; • Stakeholders in the public policy aspect of organ transplantation; and • Ethicists, anthropologists, sociologists, and legal scholars well-recognized for their writings regarding transplantation policy and practice.
No person or group was polled with respect to their opinion, practice, or philosophy prior to the Steering Committee selection or the Istanbul Summit.
After the proposed group of participants was prepared and reviewed by the Steering Committee, they were sent an letter of invitation to the Istanbul Summit, which included the following components:
™ the mission of the Steering Committee to draft a Declaration for all Istanbul participants’ consideration; ™ the agenda and work group format of the Summit; ™ the procedure for the selection of participants; ™ the work group topics; ™ an invitation to the participants to indicate their work group preferences; ™ the intent to communicate a draft and other materials before the Summit convened; ™ the Summit goals to assemble a final Declaration that could achieve consensus and would address the issues of organ trafficking, transplant tourism and commercialism, and provide principles of practice and recommended alternatives to address the shortage of organs; ™ an acknowledgment of the funding provided by Astellas Pharmaceuticals for the Summit; ™ provision of hotel accommodations and travel for all invited participants.
Of approximately 170 persons invited, 160 agreed to participate and 152 were able to attend the Summit in Istanbul on April 30-May 2, 2008. Because work on the Declaration at the Summit was to be carried out by dividing the draft document into separate parts, Summit invitees were assigned to a work group topic based on their response concerning the particular topics on which they wished to focus their attention before and during the Summit.
Preparation of the Declaration:
The draft Declaration prepared by the Steering Committee was furnished to all participants with ample time for appraisal and response prior to the Summit. The comments and suggestions received in advance were reviewed by the Steering Committee and given to leaders of the appropriate work group at the Summit. (Work group leaders were selected and assigned from the Steering Committee.)
The Summit meeting was formatted so that breakout sessions of the work groups could consider the written responses received from participants prior to the Summit as well as comments from each of the work group participants. The work groups elaborated these ideas as proposed additions to and revisions of the draft. When the Summit reconvened in plenary session, the Chairs of each work group presented the outcome of their breakout session to all Summit participants for discussion. During this process of review, the wording of each section of the Declaration was displayed on a screen before the plenary participants and was modified in light of their comments until consensus was reached on each point.
The content of the Declaration is derived from the consensus that was reached by the participants at the Summit in the plenary sessions which took place on May 1 and 2, 2008. A formatting group was assembled immediately after the Summit to address punctuation, grammatical and related concerns and to record the Declaration in its finished form.
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Participants in the Istanbul Summit
Last Name First Name Country Abboud Omar Sudan *Abbud-Filho Mario Brazil Abdramanov Kaldarbek Kyrgyzstan Abdulla Sadiq Bahrain Abraham Georgi India Abueva Amihan V. Philippines Aderibigbe Ademola Nigeria *Al-Mousawi Mustafa Kuwait Alberu Josefina Mexico Allen Richard D.M. Australia Almazan-Gomez Lynn C. Philippines Alnono Ibrahim Yemen *Alobaidli Ali Abdulkareem United Arab Emirates *Alrukhaimi Mona United Arab Emirates Álvarez Inés Uruguay Assad Lina Saudi Arabia Assounga Alain G. South Africa Baez Yenny Colombia *Bagheri Alireza Iran *Bakr Mohamed Adel Egypt Bamgboye Ebun Nigeria *Barbari Antoine Lebanon Belghiti Jacques France Ben Abdallah Taieb Tunisia Ben Ammar Mohamed Salah Tunisia Bos Michael The Netherlands Britz Russell South Africa Budiani Debra USA *Capron Alexander USA Castro Cristina R. Brazil *Chapman Jeremy Australia Chen Zhonghua Klaus People's Republic of China Codreanu Igor Moldova Cole Edward Canada Cozzi Emanuele Italy *Danovitch Gabriel USA Davids Razeen South Africa De Broe Marc Belgium *De Castro Leonardo Philippines *Delmonico Francis L. USA Derani Rania Syria Dittmer Ian New Zealand Domínguez-Gil Beatriz Spain Duro-Garcia Valter Brazil Ehtuish Ehtuish Libya El-Shoubaki Hatem Qatar Epstein Miran United Kingdom *Fazel Iraj Iran Fernandez Zincke Eduardo Belgium Garcia-Gallont Rudolf Guatemala Ghods Ahad J. Iran Gill John Canada Glotz Denis France Gopalakrishnan Ganesh India
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Gracida Carmen Mexico Grinyo Josep Spain Ha Jongwon South Korea *Haberal Mehmet A. Turkey Hakim Nadey United Kingdom Harmon William USA Hasegawa Tomonori Japan Hassan Ahmed Adel Egypt Hickey David Ireland Hiesse Christian France Hongji Yang People's Republic of China Humar Ines Croatia Hurtado Abdias Peru Ismail Moustafa Wesam Egypt Ivanovski Ninoslav Macedonia *Jha Vivekanand India Kahn Delawir South Africa Kamel Refaat Egypt Kirpalani Ashok India Kirste Guenter Germany *Kobayashi Eiji Japan Koller Jan Slovakia Kranenburg Leonieke The Netherlands *Lameire Norbert Belgium Laouabdia-Sellami Karim France Lei Ruipeng People's Republic of China *Levin Adeera Canada Lloveras Josep Spain Lõhmus Aleksander Estonia Luciolli Esmeralda France Lundin Susanne Sweden Lye Wai Choong Singapore Lynch Stephen Australia *Maïga Mahamane Mali Mamzer Bruneel Marie-France France Maric Nicole Austria *Martin Dominique Australia *Masri Marwan Lebanon Matamoros Maria A. Costa Rica Matas Arthur USA McNeil Adrian United Kingdom Meiser Bruno Germany Meši Enisa Bosnia Moazam Farhat Pakistan Mohsin Nabil Oman Mor Eytan Israel Morales Jorge Chile Munn Stephen New Zealand Murphy Mark Ireland *Naicker Saraladevi South Africa Naqvi S.A. Anwar Pakistan *Noël Luc WHO Obrador Gregorio Mexico Oliveros Yolanda Philippines Ona Enrique Philippines Oosterlee Arie The Netherlands Oyen Ole Norway Padilla Benita Philippines
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Pratschke Johann Germany Rahamimov Ruth Israel Rahmel Axel The Netherlands Reznik Oleg Russia *Rizvi S. Adibul Hasan Pakistan Roberts Lesley Ann Trinidad and Tobago *Rodriguez-Iturbe Bernardo Venezuela Rowinski Wojciech Poland Saeed Bassam Syria Sarkissian Ashot Armenia *Sayegh Mohamed H. USA Scheper-Hughes Nancy USA Sever Mehmet Sukru Turkey *Shaheen Faissal A. Saudi Arabia Sharma Dhananjaya India Shinozaki Naoshi Japan Simforoosh Nasser Iran Singh Harjit Malaysia Sok Hean Thong Cambodia Somerville Margaret Canada Stadtler Maria USA *Stephan Antoine Lebanon Suárez Juliette Cuba Suaudeau Msgr. Jacques Italy Sumethkul Vasant Thailand Takahara Shiro Japan Thiel Gilbert T. Switzerland *Tibell Annika Sweden Tomadze Gia Georgia *Tong Matthew Kwok-Lung Hong Kong Tsai Daniel Fu-Chang Taiwan Uriarte Remedios Philippines Vanrenterghem Yves F.C. Belgium *Vathsala A. Singapore Weimar Willem The Netherlands Wikler Daniel USA Young Kimberly Canada Yuldashev Ulugbek Uzbekistan Zhao Minggang People's Republic of China
* = Members of the Steering Committee. (William Couser, USA, was also a member of the Steering Committee but was unable to attend the Summit.)
ps: 台大社會醫學科副教授兼主任家庭醫學科醫師 蔡甫昌
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