Vicente Sánchez-Polo, Presidencia SLANH Guatemala
María A. Matamoros, Co-Chair DIGG/past president STALYC
Thomas Mueller, Co-Chair Declaration of Istanbul Custodian Group, Senior Advisor Swisstransplant
Lourdes C. Vásquez-Jiménez, SLANH Paraguay
Luis E. Morales-Buenrostro, STALYC
Liliana Bisignano, INCUCAI Argentina; SLANH Argentina
Guillermo Rosa-Diez, INCUCAI Argentina; SLANH Argentina; Coordinación Registro Latinoamericano Diálisis y Trasplante (SLANH)
Raúl Mizraji, STALYC Uruguay
Jorge Rico-Fontalvo, SLANH Colombia
Eliana Dina-Batle, Sociedad Dominicana de Nefrología, Pontificia Universidad Católica Madre y Maestra, Hospital Metropolitano de Santiago, Santiago, República Dominicana
Régulo A. Valdés, SLANH Panama
Idalina Stanley, STALYC, Sociedad Paraguaya de Trasplantes (SPT)
Jorge Huertas, SLANH Ecuador; Delegado de la Sociedad Ecuatoriana de Nefrología Diálisis y Trasplante; Hospital de Fuerzas Armadas No 1 Quito Ecuador
Carlos Márquez, Sociedad Venezolana de Nefrología
Carlos F. Madrid-Mancia, SLANH Honduras; Tesorería Asociación Hondureña de Nefrología y Trasplante (AHNT)
Rocío C. Arroyo, SPNH Panama
José A. Moura-Netto, SBN Panama; Presidencia de la Sociedad Brasileña de Nefrología (SBN)
María M. Papaginovic, Sociedad Argentina de Nefrología (SAN)
Mabel Sandoval-Díaz, Presidencia Asociación Nicaragüense de Nefrología (ANINEF)
María G. Orué-Simón, SPN Paraguay
María C. Carlino, Sociedad Argentina de Nefrología (SAN); CUDAIO; SLANH Comité de Salud Renal
Marta Avellán-Boza, SLANH Costa Rica; Presidencia de la Asociación Costarricense de Nefrología, Caja Costarricense de Seguro Social
Guillermo Rodríguez-Méndez, Servicio de nefrología, Hospital Dr. Rafael Ángel Calderón Guardia, San José, Costa Rica
Adhanellys Cáceres, SLANH Dominican Republic
Ana C. de la Cruz, SLANH Dominican Republic
Martín Gómez-Luján, Sociedad Peruana de Nefrología; Universidad Nacional Federico Villarreal, Lima, Perú; SLANH Perú
Sebastián Cabrera, SLANH Chile
Alejandro Ferreiro-Fuentes, Chair del Board Latinoamericano de ISN-Uruguay
Tamara Bórquez-Villagra, SLANH Chile; Hospital Regional de Concepción, Chile
Josué Castresana, SLANH Puerto Rico
Mariela Salomé, STALYC Argentina
Abbud Filho, STALYC Brasil
Aczel Sánchez-Cedillo, Sociedad Mexicana de Trasplantes, Hospital General de México, Mexico; STALYC Mexico
Paola García, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio; STALYC Colombia
Ramon Garcia-Trabanino, Vicepresidencia SLANH El Salvador
Elian Pregno, UBA Argentina
In the context of projections for Latin America, the Guayaquil Document is expected to serve as a crucial reference framework for establishing policies that ensure financial neutrality in the region. As we move towards 2030, countries in the area will likely adopt stricter measures to ensure donors do not incur economic losses from their altruistic decisions. Considering the recent legislative proposal from the United States—the End Kidney Deaths Act (H.R. 9275, 118th Congress)—which proposes a $50,000 tax deduction for living kidney donors ($10,000 annually for five years), the signing societies express their deep ethical, legal, and social concerns. Although the project states its purpose of reducing mortality from chronic kidney disease (CKD), its implementation sets a precedent that contradicts the universal principles of altruistic donation and financial neutrality enshrined in the Istanbul Declaration (2018) and the WHO Guiding Principles (2010). This document alerts health authorities, legislators, ethics committees, medical societies, and international organizations in Latin America and the Caribbean to the risks that such initiatives may pose to more fragile systems, eroding public trust and compromising distributive justice and human dignity. This document has been consensually agreed upon and approved by all nephrology societies in Latin America that comprise SLANH during the XXI Congress of SLANH, held in Guayaquil, Ecuador, from August 27 to 30, 2025. It has also been subscribed, discussed, consensually agreed upon, and approved by the transplant societies of Latin America and the Caribbean that form STALYC during the XXVI Latin American and Caribbean Transplant Congress and the V Paraguayan Transplant Congress, held in Asunción, Paraguay, from October 1 to 3, 2025.
Keywords: Altruistic donation. Istanbul declaration. Transplant ethics. Distributive justice. Protection of living donors. Sustainability of the transplant system.
