The Declaration of Istanbul was created at the Istanbul Summit on Organ Trafficking and Transplant Tourism held from 30 April to 1 May 2008 in Istanbul, Turkey. The Declaration clarifies the issues of transplant tourism, trafficking and commercialism and provides ethical guidelines for practice in organ donation and transplantation. Since the creation of the declaration, over 100 countries have endorsed the principles. Some nations have subsequently strengthened their laws against commercial organ trade, including China, Israel, the Philippines, and Pakistan. History As a consequence of the widespread shortage of organs and the increasing ease of Internet communication, organ trafficking and transplant tourism have become global problems accounting for an estimated 10% of organ transplants that are performed annually around the world. Organ trafficking, transplant tourism and transplant commercialism threaten to undermine the nobility and legacy of transplantation worldwide because of the reality associated with these practices – the vulnerable in resource poor countries (such as the illiterate and impoverished, undocumented immigrants, prisoners, and political or economic refugees) are exploited for their organs as a major source of organs for the rich patient-tourists who are prepared to travel and can afford to purchase organs. The Istanbul Summit These unethical practices were the subject of a Summit convened in Istanbul from 30 April to 1 May 2008 by The Transplantation Society (TTS) and the International Society of Nephrology (ISN). The result of these deliberations was the Istanbul Declaration on Organ Trafficking and Transplant Tourism . The development of the Istanbul Summit and Declaration was derived from a direction by the World Health Assembly in 2004 as it adopted resolution WHA57.18 urging 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’. Content of the Declaration of Istanbul The Declaration emphasizes that organ trafficking and transplant tourism should be prohibited because they violate the principles of equity, justice and respect for human dignity. The Declaration asserts that because transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice and should also be prohibited. Although the World Health Assembly 2004 resolution was unambiguous in its objection to trafficking and transplant tourism, a comprehensive description of these unethical practices was still needed. Organ trafficking, transplant tourism and transplant commercialism are now defined by the