It's no holiday!

It's no holiday!
Companies try to make medical tourism seem like purchasing any other consumer item, but consumers should know how kidneys are bought and sold

Leigh Turner
Ottawa Citizen Special

Wednesday, November 14, 2007

Researching overseas "transplant tourism" I find myself surfing the website of a company located in the Philippines. I scroll past the ads for cosmetic surgery and click the ad for a kidney transplant. The website asks me whether I want to add the kidney transplant package to my shopping cart, as if I were buying a book or DVD.

Organ brokers connect individuals wanting to buy kidneys to poor individuals desperate for cash. As organ sales -- illegal in most countries -- drop in India, China and Pakistan, brokers are shifting to the Philippines as their main source of kidneys.

One Australian company sells kidney transplants in the Philippines for $55,000 U.S. The price includes all hospital, broker and organ provider fees. A hospital in the Philippines offers two rates for kidney transplants. The five-star package costs $80,000. The three-star package costs $65,000. Both prices include $3,000 for a "charity donation" to the organ "donor." Liver4you, a business that sells liver and kidney transplants in the Philippines, advertises kidney transplants for $35,000 to $85,000.

Overseas Medical Services, a Canadian company advertising organ transplants in the Philippines, doesn't list prices. But the company website mentions that once organ recipients return to Canada the cost of post-transplant care is covered under provincial health plans. This means taxpayers pay the bill if diseases are transplanted with the organs.

Websites of organ brokers and medical tourism companies try to make buying kidneys seem like purchasing other consumer items. But human kidneys aren't the same as kidney beans. What organ brokers fail to disclose is how kidneys are bought and sold.

Philippine government officials periodically engage in public hand-wringing about the country's market in organs. But despite these theatrics, the government supports commercial organ transplantation. The Philippine Information Agency, a government body, advertises that kidney transplants in the Philippines can be purchased for as little as $25,000.

Government officials work with transplant physicians and hospital executives to increase the flow of international patients flying to the Philippines for kidney transplants. Doctors from the country's leading kidney transplant institute -- a government hospital -- are part of the medical tourism road show supported by the Philippine government. Government officials want to double the number of foreign patients buying kidney transplants at Philippine hospitals. They plan to make medical tourism an economic engine for the Philippines.

The Philippines' medical tourism industry faces many obstacles. India offers cheaper medical facilities. Singapore has better hospitals. The Philippines' major "competitive advantage" is that it has a significant number of citizens living in poverty as well as a government that permits organ sales.

Some economists and philosophers argue that individuals should be free to sell body parts. This emphasis on "autonomy" does not map onto the grim reality of how organs are solicited by brokers and sold by easily exploited and often desperate slum dwellers.

Individuals who sell organs are rarely told about the consequences of having a kidney removed. Dockyard workers and street vendors often discover only after selling a kidney that they can no longer perform demanding physical labour. They commonly have no access to health care after kidney removal. They cannot get treatment if they suffer complications.

Selling a kidney does not help poor individuals escape from poverty. Instead, they find themselves targeted by debt collectors and unable to keep the small sums they are paid for their kidneys. Individuals who sell a kidney are rarely paid what they were promised, and if they try to recover promised payments from local organ brokers they can be threatened or beaten. When sellers are paid, they typically earn less than $2,000.

Just as poor individuals are harmed by selling a kidney, buyers are sometimes harmed by the very procedure that was supposed to improve their health. Purchased kidneys are often not properly screened or transplanted. The medical literature on transplant tourism describes the many dangers associated with buying organs in such countries as the Philippines and China.

Legislators, medical associations and patient groups wanting to promote organ donation rather than organ sales need to understand how easily organ trafficking crosses national borders. In most countries, legislation related to organ transplantation prohibits buying and selling of organs within national boundaries. However, commercial organ transplantation occurs across international networks.

We need laws and enforcement mechanisms capable of stopping Canadian citizens from buying organs from desperate individuals living in some of the poorest places on earth. Individuals considering buying an organ in the Philippines or elsewhere should understand that purchased organs are often inadequately screened, transmit infectious diseases, and are not transplanted according to international clinical standards. Little of the money they pay goes to the person who provides the organ. And finally, individuals selling kidneys are usually in poor health and live in extreme poverty.

Despite the many perils associated with buying human organs, Canadians are among the patients purchasing kidney transplants in the Philippines. They should be fully aware of what this entails.

Leigh Turner is an associate professor and William Dawson Scholar in the Biomedical Ethics Unit at McGill University.

http://www.canada.com/ottawacitizen/news/opinion/story.html?id=d3740c74-2b5b-4db7-a17a-c02d558500e7