Condemnation of Organ Trafficking Comes with a Challenge

ASN: Condemnation of Organ Trafficking Comes with a Challenge

By Kate Johnson, Contributing Writer, MedPage Today
Published: November 12, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

PHILADELPHIA, Nov. 12 -- U.S. physicians must strengthen their attempts to address the national shortage of transplant organs, in light of an international condemnation of organ trafficking said a panel of nephrologists urged.

"If we want to prevent organ trafficking, commercialism, and transplant tourism, we have to provide our patients with alternatives," Mohamed Sayegh, M.D., of Harvard Medical School, told attendees at the American Society of Nephrology meeting here.

The call comes following the August online publication of The Declaration of Instanbul, which condemns the worldwide increase in organ trafficking, transplant commercialism, and transplant tourism in the Clinical Journal of the American Society of Nephrology..

U.S. citizens are travelling abroad in increasing numbers to obtain kidney and other organ transplants, often from living donors in developing countries who are coerced with financial incentives, said Dr. Sayegh, who helped draft the document.

The declaration is the combined effort of representatives from 78 countries, many of which report serious health consequences and death of poor donors who are paid for their organs, said Edward H. Cole, M.D., another contributor to the document, and a nephrologist from the University of Toronto.

"I now have no hesitation counseling my patients against this means of obtaining an organ because I tell them that they are paying to abuse another human being," he said.

Transplant tourists -- U.S. residents who travel abroad to receive an organ transplant -- also face increased risks compared with transplant patients who are operated on within the U.S., according to a study published in the November issue of the Clinical Journal of the American Society of Nephrology.

Researchers at the University of California, Los Angeles, examined the medical history of 33 California residents who traveled abroad for kidney transplantation and returned to UCLA for follow-up.

Compared with a matched cohort of 66 patients who received their transplants at UCLA, the transplant tourists had a higher incidence of acute rejection (30% versus 12%).

In addition, the researchers said, 27% of transplant tourists were hospitalized for infection compared with 9% of the controls.

"Transplant tourism is a risky option for patients who are awaiting kidney transplantation, and its implications on public health warrant further evaluation," noted the authors.

In discouraging organ trafficking, physicians must double their efforts to improve other sources of organs, such as deceased donor programs, said Adeera Levin, M.D., from the University of British Columbia, another contributor to the Declaration of Istanbul.

Additionally, physicians must educate patients about the success and convenience of nocturnal dialysis. "This is not 1976. Dialysis is not necessarily such an awful thing anymore. We need to tell our patients about the benefits of nocturnal dialysis as a bridge to transplant," she said (See: ASN: Home Dialysis Gaining Momentum).

Disincentives to living donation must also be removed, said William Harmon, M.D., medical director of the kidney transplant program at Children's Hospital, Boston.

"The Declaration of Instanbul clearly indicts the U.S. system," he said. "One of the main principles it puts forth is that the transplant program has an obligation to take care of the donor -- it should provide health insurance and disability insurance. In the U.S., donors are on their own."

But an attendee at the meeting who was not involved in drafting the declaration had some sharp criticism for the panel.

"I absolutely agree with the spirit of the declaration," said Fadi Lakkis, M.D., scientific director of the Thomas E. Starzl Transplantation Institute at the University of Pittsburgh.

"But we cannot ban organ trafficking outright until we have fixed deceased organ donation here and elsewhere. All we will be doing is to drive it undergound."

Dr. Lakkis proposed an alternative approach -- allowing organ sales under careful supervision and controlled circumstances.

Primary source: Clinical Journal of the American Society of Nephrology
Source reference:
Participants in the International Summit on Transplant Tourism and Organ Trafficking "The Declaration of Istanbul on Rogan Trafficking and Transplant Tourism" Clin J Am Soc Nephrol 2008; 3: 1227-1231.

Additional source: Clinical Journal of the American Society of Nephrology
Source reference:
Gill J, et al "Transplant Tourism in the United States: A single-Center Experience" Clin J Am Soc Nephrol 2008; 3:1820-1828.