Comment 6 www.thelancet.com Vol 372 July 5, 2008 Selective factor Xa inhibition for thromboprophylaxis Published Online June 25, 2008 DOI:10.1016/S0140- 6736(08)60879-X See Articles page 31 transplants, are just beginning to address their respective responsibilities to protect their people from exploitation and to develop a national self-sufficiency in organ donation. Leadership and encouragement from transplant professionals would contribute greatly to governments taking effective action to adopt and then to enforce strong laws consistent with the declaration. Participants in the Istanbul meeting have already played major roles in the promulgation of such laws and regulations within the past 2 years in China, Pakistan, and the Philippines. The implications of the declaration’s definitions, principles, and recommendations are profound. The declaration will reinforce the resolve of governments and international organisations to develop laws and guidelines to bring an end to wrongful practices. The declaration calls for transparent regulatory oversight— with international accountability—that ensures the safety and wellbeing of donors and recipients alike. Still, more is needed from the transplant and medical communities. The Transplantation Society and the International Society of Nephrology have endorsed the declaration. The steering committee has created task forces to facilitate dissemination of the declaration to national health authorities and to supplement existing professional standards. Recommendations from these task forces ought to include cancelling the professional society membership of individuals who do not adhere to the principles of the declaration. Drug companies and other funding agencies ought to apply the declaration’s principles when supporting research and other clinical activities. Journals ought not to publish studies from individuals or groups who do not comply with the declaration. The legacy of transplantation is threatened by organ trafficking and transplant tourism. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism aims to combat these activities and to preserve the nobility of organ donation. The success of transplantation as a life-saving treatment does not require—nor justify— victimising the world’s poor people as the source of organs for the rich. Steering Committee of the Istanbul Summit* dma@transplantation-soc.org *Steering Committee: Mario Abbud-Filho, FAMERP and Institute of Urology and Nephrology, Sao Paolo; Mustafa Al-Mousawi, Middle East Society for Organ Transplantation, Kuwait City; Ali Abdulkareem Alobaidli, Kidney Transplant Services, Sheikh Khalifa Medical City, Abu Dhabi; Mona Nasir Al-Rukhaimi, Renal Unit, Dubai Hospital, Dubai; Alireza Bagheri, Tehran University of Medical Sciences; M A Bakr, Urology & Nephrology Centre, Mansoura University, Mansoura; Antoine Barbari, Rafik Hariri University Hospital, Beirut; Alexander Capron, University of Southern California, Los Angeles; Jeremy R Chapman, The Transplantation Society and University of Sydney; William Couser, International Society of Nephrology, Seattle; Gabriel Danovitch, David Geffen School of Medicine at UCLA; Leonardo D de Castro, University of the Philippines, Quezon City; Francis L Delmonico, The Transplantation Society, Boston; Iraj Fazel, Academy of Medical Sciences, Tehran; Mehmet Haberal, Baskent University and Turkish Transplantation Society, Ankara; Vivekanand Jha, Postgraduate Institute of Medical Education and Research, Chandigarh; Eiji Kobayashi, Jichi Medical University, Tochigi; Norbert Lameire, University Hospital, Ghent; Adeera Levin, University of British Columbia, Vancouver; Mahamane Kalil Maïga, University of Bamako; Dominique Martin, Centre for Applied Philosophy and Public Ethics, University of Melbourne; Marwan Masri, Asian Society of Transplantation, Beirut; Saraladevi Naicker, University of the Witwatersrand, Johannesburg; Luc Noël, WHO, Geneva; S Adibul Hasan Rizvi, Sindh Institute of Urology and Transplantation, Karachi; Bernardo Rodriguez-Iturbe, International Society of Nephrology, Maracaibo; Mohamed H Sayegh, Harvard Medical School, Boston; Faissal AM Shaheen, Saudi Council for Organ Transplantation, Jeddah; A G Stephan, Nephrology Division, Rizk Hopsital, Beirut; Annika Tibell, Karolinska Institute, Stockholm; Matthew Kwok-Lung Tong, Princess Margaret Hospital, Hong Kong; and A Vathsala, National University of Singapore. The Istanbul Summit was supported by an unrestricted grant to The Transplantation Society from Astellas Pharmaceuticals. The members of the Steering Committee declare that they have no conflict of interest. 1 World Health Assembly. Development of guiding principles for human organ transplants: WHA40.13. Geneva: World Health Organization, 1987. 2 World Health Assembly. Preventing the purchase and sale of human organs: WHA42.5. Geneva: World Health Organization, 1989. 3 World Health Assembly. Human organ transplantation (adopting the WHO Guiding Principles on Organ Transplantation): WHA44.25. Geneva: World Health Organization, 1991. 4 World Health Assembly. Human organ and tissue transplantation: WHA57.18. May 22, 2004. http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_ R18-en.pdf (accessed June 16, 2008). 5 Shimazono Y. The state of the international organ trade: a provisional picture based on integration of available information. Bull World Health Organ 2007; 85: 955–62. 6 Naqvi SAA, Ali B, Mazhar F, Zafar MN, Rizvi SAH. A socioeconomic survey of kidney vendors in Pakistan. Transpl Int 2007; 20: 934–39. For over 60 years, vitamin K antagonists, such as warfarin, have been the only available oral anticoagulants. Although effective, these drugs are challenging to use. Dose requirements vary among patients and the anticoagulant response is unpredictable. Consequently, coagulation needs to be monitored and the dose frequently adjusted to ensure that a therapeutic level of anticoagulation is achieved. Such monitoring is inconvenient for patients and costly for health-care systems.