The Declaration of Istanbul and its Custodian Group a historic initiative of The Transplantation Society. Twenty-five years after it was imagined, we are back in the city of its launch, an opportune time to take stock. Of the global state of transplant commercialism, organ trafficking and transplant tourism. What was the context for the statement? What has it accomplished? Is it a thought current or an action plan? Is it out-of-date or still relevant? How has transplant commercialism metamorphosed? And what are the contemporary challenges? This symposium will bring together speakers from those involved in the 2008 Istanbul Summit to those currently active as well as its future leadership for reflection, exchange and imagining the future.