Transplant Surgery abroad is not the same in every country

[Zach]

Folks, stauffenberg already has a transplant--for about a year, from what I can gather.
Whether or not it is from a young Philippine organ donor, who knows.

Gives a whole new meaning to 'the Professors and their young teaching assistants.'         

Before I developed renal failure, I was living a hyperactive life as a university professor at two separate universities, one in England and one in Germany.  Suddenly, however, I was struck down by Wegener's Vasculitis, an extremely rare autoimmune disease which transformed me from a healthy, young-llooking man in his forties to a feeble renal paitient in the span of just two weeks.  I spent eight years on dialysis, during which I was unable to work and endured a kind of living death, during which my existence was plagued with hypersomnia, constant nausea and vomiting, itching, difficulty concentrating, and exhaustion -- despite my rigid adherence to the renal diet and 15 hours of hemodialysis a week.  Eventually I got a transplant, and the effect was immediate and remarkable, since I felt truly awake for the first time in years just minutes after coming out of the recovery room following the operation.  In the year since then, I have been able to return to work and feel about 80% as healthy as I did before renal failure.  The main limitations I experience are from clouding of the vision due to cataracts forming in response to the prednisone dose; tiredness from persistent low hemoglobin levels; and severe, month-long illness when I get the winter flu.  Still, I feel incomparably more healthy than I did on dialysis, and now realize that I was unable to perceive during dialysis exactly how far I had dropped below the level of normal living.

[meadowlandsnj]

To me it's just bad karma to take advantage of a poor person who gets $7000 for a kidney.  Follow up care for these people?  Please............we all know better that there is no such thing.  You can make it sound as pretty as you want to, wrap it up in a box and tie a pretty red ribbon on top but BS stinks no matter what you wrap it in.  It's exploitative and it's just not right.  Everything I've read about this in the last 5 years or so tell me this.  Look up Moldavia and organ selling.  South Africa is in the organ selling business also.  Why is it the poorest countries and the poorest people are doing this?  Why are the richest people from the richest countries in the world doing this?  Kidneys or other organs are not commodities to be bought or sold.

Impoverished Indians who sell their kidneys in an effort to escape poverty suffer financially and medically in the long run, a new study has found (JAMA 2002;288:1589-93).

The study has broad ethical and social implications for the prospects of increasing the available organ transplant pool through organ sales, and suggests that financial incentives to increase the pool of donors may backfire.

India has a large population of patients with end stage renal disease, and dialysis is not widely available. It also has a chronic shortage of organs available for donation. Consequently, India harbours a thriving black market in organ trade.

Dr Mahdav Goyal and Dr Ravindra Mehta from the Geisinger Health System in Pennsylvania and colleagues from the Case Western Reserve University in Ohio and the University of California School of Medicine at San Diego conducted a cross sectional survey of people in India who had sold their kidneys.

The survey looked at the long term economic and health effects on the participants of selling a kidney and catalogued the underlying motivation for organ selling, the amount received from the sale, how the money was spent, changes in economic and health status in the six years after the sale, and what advice they would give to other people considering selling a kidney.

The survey was conducted in Chennai (Madras), Tamil Nadu. Because organ trade is illegal, the survey was conducted in a clandestine, door to door fashion by a team of eight Tamil speaking research assistants.

A total of 305 kidney donors were identified and participated in the study during February 2001. Nephrectomy was verified by presence of scars. The donors were paid 40 rupees (£0.53; $0.83; ¤0.84) for participating in the survey. Ninety five per cent of the men and 60% of the women worked in low paid jobs such as labourers or vendors.

Nearly all the participants sold a kidney for financial reasons, with 292 (96%) indicating that paying off debts was the prime motivating factor. Three per cent sold their kidneys to provide dowries and marriage expenses for their daughters, while 1% required cash to start a business. Seventy per cent sold their kidney through an intermediary and 30% directly to a clinic or individual.

The average payment for a kidney was $1070 (£638; ¤1090)--a third lower than the average amount promised--and the sums ranged from $450 to $2660.

Of the 292 participants who sold a kidney to pay off debts, 216 (74%) still had debts at the time of the survey.

[stauffenberg]

Why worry about unethical practices in Moldova and India when in the Philippines the practice of buying kidneys for transplant is the normal custom of the country and so is an integral part of the whole normative structure of the society?  Before any paid organ donation can proceed, a hospital ethical committee consisting of a psychiatrist, a nephrologist, and a Roman Catholic priest has to approve it.  Obviously the approval would not be forthcoming if the donor were under duress, if he did not understand the choice he was making, if he were not being paid enough, and if he were medically unsuitable.  So why leap to the conclusion that this has to be unethical when a society of seventy million people finds it normal practice?

It also seems to be assumed on this message board that living with just one kidney is some dire medical problem which requires constant, intensive, and expensive medical follow-up, when in fact the medical literature shows that this is not the case. Many people are born with only one kidney and this is never known until it is discovered at autopsy or by chance at a routine x-ray.  The 'intact nephron hypothesis' maintains that when people lose a kidney, the nephrons remaining increase their functional capacity so that the loss in number of nephrons is made up.  People declining into endstage renal failure can often stay off dialysis with only 10% renal function, and someone with 50% renal function would be totally asymptomatic.  Studies of renal donors show that they live as long as the normal population and have no higher rates of morbidity.  Organ transplant patients generally feel quite well with one kidney and only have to have intensive medical follow-up because, with a transplanted rather than a native kidney, they face chronic allograft nephropathy, and also have to have their immunosuppressive dosage and side-effects monitored.  This is not so with someone who gives up a kidney, whose only lifestyle change may be that he should drink a little more water than the average person.  Also, in the Philippines at least, only donors with excellent renal function, no history in their families of renal disease, and perfect health are accepted by the ethical committees, so they are well selected to deal with living with just one kidney.  Kidney disease which affects only one organ is extremely rare, so they do not lose any advantage against future renal illness by having only one organ instead of two.

If you base your ethical thinking on what achieves actual human happiness rather than on vague, metaphysical values which have no practical meaning in human terms, you would have to admit that there is more net happiness in the world when an organ donor sells his kidney to a dialysis patient, since both the donor and the patient consider themselves better off than before, and there is no discernible 'victim' in the exchange.  But the healthy majority of people, who don't care about sick people, who don't understand what their lives are like, and who don't even like them, decide to declare paid kidney donation illegal or unethical because of their thoughtless, knee-jerk reaction to the image of the 'organ trade' and of 'transplant tourism,' and their aesthetic dislike for the 'violation of the sacredness of the human body.'  But dialysis is the real violation of the sacredness of the human body, not the voluntary removal of a duplicate organ to save someone else's life.

In France in the 1960s it was illegal for family members to donate a kidney because it was imagined that they would be under too much duress from the sick person to make a truly free decision.  In many Asian countries all organ donation has been illegal because it violated vague, rationally indefensible cultural norms.  In Canada altrusitic donation, perfectly legal in the U.S., is forbidden, because it is imagined that all altruistic donors must really be paid donors.  Paired organ donation, which has saved many lives in the U.S., is also forbidden in Canada, because the Canadian Medical Association feels it needs another decade or so to study the question, all the while patients are dying around them left and right.  The fact that the rules the healthy majority makes for the oppressed minority of dialysis patients are so arbitrary and varied strongly suggests that they have no rational basis, but arise just from the majority's desire 'to keep the cripples in their place.'

If half the population of the world had endstage renal failure and the other half was healthy, what would the laws on organ purchase be?  Would the society be content to watch all its resources eaten up by the cost of dialysis, to have half its population suffering all the time, to lose productivity for the many people unemployed, to have the hospitals overcrowded with cases of dialysis-induced morbidity, and to watch the average life expectancy sink from premature deaths on dialysis?  I doubt it.  On the contrary, there would either be laws confiscating all the surplus kidneys in society from the healthy half of the population and transplanting them into the sick half, or there would be compulsory purchase of organs, or at the very least voluntary organ sales would be allowed.  So if the majority would react this way if dialysis were a large-scale problem, what is their moral basis for making organ purchases illegal just because it is a relatively small-scale problem?

The healthy majority understands the vulnerable minority of dialysis patients as little as Southern racists in the first half of the 20th century understood the Blacks they oppressed, and yet we take the majority's word for it when we accept their ignorant ethical rules for governing our situation, which we all know they don't understand in the least.  I think every renal patient owes it to himself to liberate himself from an ethical system made for us by people who don't understand the plight we are in, and to look with an open mind at the real ethics of organ transplant purchase.

[Zach]

What happens when the young man decides not to donate at the last minute, and I have spent all the time and money to come to the Philippines?  Do I take this impoverished young man to court to recoup my financial losses on this transaction?

Will Medicare accept a foreign transplant and cover the drugs it normally does for domestic transplants?

What happens when the transplant fails, say in two years.  Do I receive a partial refund?  Is there any warranty as with other items I buy on the market?   

I'm not making any moral or ethical judgment ... everyone else here is making a good case.   I'm looking at whether it is or isn't a good business arrangement.  As business deals go, it has much too many risks and only a few benefits.  It just doesn't cut it!  Pardon the pun.     

[stauffenberg]

What is sold to the transplant candidate is the full transplant procedure plus the normal follow-up time in the hospital, which is about 10 days.  In addition, the patient is given two weeks of immunosuppressive medications to take home with him.  If the donor backs out at the last minute and the transplant does not take place, of course the transplant candidate does not owe any money for the services he has not yet received.  In the Philippinnes it is not difficult to find a replacement donor, so the only problem for the transplant candidate would be having to wait for the new donor's blood typing, HLA testing, cross-match, medical fitness exam, and ethical committee screening to be completed.

No one in any country under any circumstances, in the public system or in the private system, can give you a guarantee on the future outcome of a transplant.  If you get a cadaver organ in the U.S., the hospital, the nephrologist, the surgeon, and the dialysis unit are not going to pay you some compensation just because the organ fails soon after the transplant!  However, since in the Philippines you would only get a well-matched kidney from a live donor, the chances of getting a long-lasting kidney are many times greater than if you got a cadaver organ in the U.S.

Medicare pays for immunosuppressive drugs for three years after the transplant for anyone who was on dialysis under the Medicare/Medicaid system.  The rules don't confine eligibility to those getting a transplant in the U.S. as far as I know, especially since many people with relatives in foreign countries have to travel abroad for their transplant from an altruistic donor. 

[angieskidney]

only 2 weeks?
That is not a lot .. hopefully Medicare would be fast in taking over

It also seems to be assumed on this message board that living with just one kidney is some dire medical problem which requires constant, intensive, and expensive medical follow-up, when in fact the medical literature shows that this is not the case. Many people are born with only one kidney and this is never known until it is discovered at autopsy or by chance bla bla bla same old crap as stated earlier

There ya go assuming again. We KNOW that a person can live with one kidney. BUT you are pushing one side so much and not respecting the other side. Like meadowlandsnj said...

Impoverished Indians who sell their kidneys in an effort to escape poverty suffer financially and medically in the long run, a new study has found (JAMA 2002;288:1589-93).

We would be more inclined to accept all you say as fact IF you were openly weighing the pros and cons, instead of trying to sell us on this idea of paying for organs in the Philippines.

But the healthy majority of people, who don't care about sick people, who don't understand what their lives are like, and who don't even like them, decide to declare paid kidney donation illegal or unethical because of their thoughtless, knee-jerk reaction to the image of the 'organ trade' and of 'transplant tourism,' and their aesthetic dislike for the 'violation of the sacredness of the human body.' But dialysis is the real violation of the sacredness of the human body, not the voluntary removal of a duplicate organ to save someone else's life.

But you are not talking to the healthy majority of people here now are you? You are talking to people who are going through this so that means that how we feel and our stance on this will be stronger than them and for damn good reason! If you are gonna successfully talk anyone into this then you had better come up with a better way .. like how about .. numbers, facts, phone numbers, PROOF of success and actual people's after donation stories. We aren't just selfish people who want a kidney and don't care at what cost. We DO care. We care about the donor and not just about the kidney. How you talk, you seem to want us to be selfish and just want the kidney and hand over money. For myself, that will never happen as I can't even afford to buy a used car, much less a used kidney!

In Canada altruistic donation, perfectly legal in the U.S., is forbidden, because it is imagined that all altruistic donors must really be paid donors. Paired organ donation, which has saved many lives in the U.S., is also forbidden in Canada, because the Canadian Medical Association feels it needs another decade or so to study the question, all the while patients are dying around them left and right.

Dying left and right? Damn .. then I guess I should be dead and everyone in my unit eh? Yet here I am back to work and planning on marriage and having children .... what a fool am I eh? 

If half the population of the world had endstage renal failure and the other half was healthy, what would the laws on organ purchase be? Would the society be content to watch all its resources eaten up by the cost of dialysis, to have half its population suffering all the time, to lose productivity for the many people unemployed, to have the hospitals overcrowded with cases of dialysis-induced morbidity, and to watch the average life expectancy sink from premature deaths on dialysis? I doubt it. On the contrary, there would either be laws confiscating all the surplus kidneys in society from the healthy half of the population and transplanting them into the sick half, or there would be compulsory purchase of organs, or at the very least voluntary organ sales would be allowed. So if the majority would react this way if dialysis were a large-scale problem, what is their moral basis for making organ purchases illegal just because it is a relatively small-scale problem?

Are you trying to make it sound like the only way to save the world is live donations from other countries? What about cadaver kidneys? I could get a live donor kidney for FREE in my country but I choose NOT to ... so obviously you are missing the real reason people say no.

The healthy majority understands the vulnerable minority of dialysis patients as little as Southern racists in the first half of the 20th century understood the Blacks they oppressed, and yet we take the majority's word for it when we accept their ignorant ethical rules for governing our situation, which we all know they don't understand in the least. I think every renal patient owes it to himself to liberate himself from an ethical system made for us by people who don't understand the plight we are in, and to look with an open mind at the real ethics of organ transplant purchase.

plight WE are in? Hmmm... well I don't feel like I am in any plight but okay...

I think if anything, kidney disease and dialysis needs to get more recognition much like AIDS did or Cancer or Gay Rights even. If you spent half as much time talking about signing your donor card then maybe there would be more cadaver kidneys considering how many deaths happen daily all over the world. And as for believing the word of the majority?? Excuse me but I am one of the managers of a site run by Dialysis Nurses, Nephrologists and Techs. I think they know their facts and they provide me with the facts. They care very much about their patients and is thus why they made the site at Dialysis & Transplant City. Also all of us here have done research and are NOT just taking the majority's word. We know that the news doesn't always have it right. We know that even some kidney sites (Sandman and I ran across one that said transplants were a cure in some cases .. only case I could think of is between identical twins but they didn't say that). But we as dialysis patients and some of us past transplant recipients know that we have to be in charge of our own health and find the facts ourselves! Telling us to take a stand against our oppressors is NOT going to do anything. Since we are NOT oppressed.

[sandman]

I think a lot of people are not fully aware of what after effects a live donor is subject to.  Of course, a healthy person should maintain a proper diet and all but they can indulge a bit from time to time.  More so then someone who MUST maintain a proper diet like an ESRD patient.  But did you know that a donor is subject to the possability of developing hypertension because they donated a kidney?  Have a read here.  http://www.webmd.com/content/article/125/116104

[angieskidney]

Very good post Sandman 

also on top of that there is the risk of infection (don't think it never happens!). See here!


ALso I wanted to ask this: If there is no problem in the Filipinos giving kidneys away, why does it say in this article that they are dying at a high rate due to kidney disease. How can they give kidneys away to people who pay and not to their OWN people? Something seems fishy to me about that.

[Zach]

If the donor backs out at the last minute and the transplant does not take place, of course the transplant candidate does not owe any money for the services he has not yet received.  In the Philippinnes it is not difficult to find a replacement donor, so the only problem for the transplant candidate would be having to wait for the new donor's blood typing, HLA testing, cross-match, medical fitness exam, and ethical committee screening to be completed. 

That situation would be a nightmare for most people.

[sandman]

ALso I wanted to ask this: If there is no problem in the Filipinos giving kidneys away, why does it say in this article that they are dying at a high rate due to kidney disease. How can they give kidneys away to people who pay and not to their OWN people? Something seems fishy to me about that.

I don't know but if I had to guess, I would think that would be because the people in question can not afford proper health care or that the medical staff handling these cases are not as efficient as they are else where. 

But that is just a guess since I have no proof to back up my opinions.  Can anyone shed some factual light on this subject please?

[Sluff]

Very good post Sandman 

also on top of that there is the risk of infection (don't think it never happens!). See here!


ALso I wanted to ask this: If there is no problem in the Filipinos giving kidneys away, why does it say in this article that they are dying at a high rate due to kidney disease. How can they give kidneys away to people who pay and not to their OWN people? Something seems fishy to me about that.

I think the link from WEB MD pretty much explains it.    Thanks Angie,

[stauffenberg]

I am deliberately presenting just one side of the paid organ donation debate because everyone else on this message board seems to be presenting the other side, which thus does not need any help from me.

Even though I am speaking to a message board for dialysis patients, I am criticizing the attitudes of the healthy majority because it is these attitudes which inform the ethical assumptions and laws which most message board members seem to take as the Gospel truth.  But in fact, the rules which the healthy majority has the gall to impose on a vulnerable minority whose experience they do not understand at all are based on a complete failure to appreciate the dialysis patient's side of the ethical balance between the interests of the organ donor and the desperate needs of the organ recipient.  Since the healthy majority thinks most people are to blame for their own kidney failure and believes that cadaver organs are in abundant supply, are just as good as organs from living donors, and are given to patients after a very short waiting time, and also assumes that dialysis is an easy treatment to endure, their theory that we are just exploiting poor foreigners if we pay for a foreign transplant is based on a gross misapprehension of the reality behind that choice and, as such, deserves no respect from people who, through their own experience, know better.

One poster here seems to like dialysis and does not believe my statement that dialysis patients are 'dying left and right,' but the fact is that dialysis vastly shortens life expectancy, and the death rate among dialysis patients in most first world countries is 9 to 13% a year, which is about the same as the death rate among the soldiers in the trenches on the Western Front during the First World War, which most people regard as an unendurably high risk, even when it lasts only for the duration of the war, four years, rather than for a lifetime, as dialysis without a transplant does.  And as I pointed out in another message to this forum, the dialysis death rate in the U.S. is twice as high as in the rest of the developed world, mainly thanks to the for-profit dialysis delivery system, which cuts corners to make profits at the patients' expense.

It is true that kidney donors face a higher risk of hypertension than most people, but if you look at the scientific literature, this elevated pressure is not clinicallly significant.  There is also the chance of infection, as well as the one in 3000 risk of dying during the organ removal operation, which is the same as the transplant recipient's risk of dying during his operation.  But the fact that organ donors have exactly the same life expectancy as normal, healthy individuals who never donate an organ is proof that all the health risks combined are not serious.  Given that the risks, though real, are within the range of acceptable trade-offs, especially given that the Filipino donor goes from being a poor man to a rich man, by local standards, overnight because he has accepted these risks, the buying of organs for donation is NOT EXPLOITATION, since the danger to the donor is not outside the realm of what a rational person would accept for a major improvement in his financial situation, even though people may have different subjective views about whether they would accept that risk for themselves.  It is like skydiving: I would never want to risk it, but I can see how other sane people might think the risks worth the thrill, so I would not want to make it illegal.

Almost everyone in the Philippines, medical tourists from the West as well as Filipinos, has to get a kidney transplant from a paid donor, since most hospitals will not transplant cadaver organs, and few are donated anyway.  The reason people in the Philippines die of kidney failure is that, with an average salary of $2000 a year, they cannot afford to pay a donor or the surgeon for the operation.  The Filipinos I met who had had kidney transplants all had relatives in the United States who had saved part of their salary to give to the relative back home to pay for the transplant.

It is not realistic to say that it would be "a nightmare," as one poster described it, to have the kidney donor back out at the last moment, since that would just mean that the transplant candidate would have to wait in the Philippines for another two or three weeks while a new donor was being tested and screened by the hospital ethics committee.  Believe it or not, even some perfectly healthy Westerners deliberately travel to the Philippines for two or three weeks just for the pleasure of being tourists in a country with lots of sun, friendly people, and sandy beaches, and they wouldn't describe their stay as a "nightmare."

[sandman]

stauffenberg.  Thank you for that well said post as you have answered quite a few of my questions here. 

[Mike]

One poster here seems to like dialysis and does not believe my statement that dialysis patients are 'dying left and right,' but the fact is that dialysis vastly shortens life expectancy, and the death rate among dialysis patients in most first world countries is 9 to 13% a year, which is about the same as the death rate among the soldiers in the trenches on the Western Front during the First World War

You clearly know nothing mate, the mortality rate amongst renal patients in the united states is in FACT 0.1743% ! And I imagine that the death rate in the oh so wonderful Philippines you see through your rose tinted specs is a lot higher

Try to do your homework before coming on here with your stats you have picked out of the air. It is offensive to the memories of the 65 MILLION people who died in the first world war. The actual stats for combat death in ww1 was in fact 67.4%

What happens to these donors after you have told them to bugger off with their paltry 7 grand, Do you supply full medical check up for the rest of their lives like a live donor in the states or UK would. I somewhat doubt it! They are more likely than not made to pay for their healthcare from the tiny amount of money you have given them.

How do you feel about this then ?

http://www.pia.gov.ph/news.asp?fi=p050224.htm&no=6
In the U.S., the average cost of transplant is $120,000 or more than P6 million. In the Philippines, one set of laparascopic transplants would only cost a patient P300,000.

"The Philippines has the cheapest kidney transplant cost. However, most Filipinos cannot afford such surgery because the money comes out of their own pockets," Filipino nephrologist Dr. Franklin Guillano said.

Bretan said in the U.S., the government pays for the people's dialysis treatments and even kidney transplantation.

"No one in the U.S. can pay $65,000 for dialysis per year," he said as he explained how comprehensive medical care programs had become an important part in the lives of Americans.

In the Davao region alone, a Philippine study on nephrology showed that out of 854 ESRD patients, only 122 underwent dialysis treatment.

"Two-thirds were not able to undergo such treatment, neither were they hospitalized for such disease. Most patients on dialysis also ran out of money in three to six months time which caused their death," Guillano bared.

or what do you have to say about this..

http://www.mja.com.au/public/issues/182_05_070305/ken10034_fm.html
Lack of donors has led to a worldwide increase in commercial kidney transplantation programs where recipients acquire kidneys either from executed prisoners or live non-related donors.

Commercial transplantation is prohibited by legislation in Australia.

Our centres have had 16 patients who have travelled overseas to receive a commercial kidney transplant; five have subsequently died.

As has been found previously, patients who received commercial transplants were more likely to develop infections such as HIV, hepatitis B virus, cytomegalovirus and fungal infections.

Previous reports have found that patient and graft survival were comparable to local results, whereas we found that patient and graft survival were worse than transplantation within Australia.

Patients considering the option of overseas commercial donation should be advised that heightened risks to life and graft survival exist.

besides it is still ILLEGAL in the Philippines despite what you may believe 

http://www.humantrafficking.org/updates/134
Philippines ratified the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children supplementing the United Nations Convention on Transnational Organized Crime on September 30, 2001. The definition of trafficking in persons in the Philippine's bill is very similar to that of the Protocol. The version of the bill on Anti-trafficking passed in the House of Representatives defines trafficking in persons as "the recruitment, transportation, transfer or harboring or receipt of persons with or without the victim's consent or knowledge through legal or illegal means within or across national borders by means of threat or use of force or other forms of coercion, abduction, fraud, deception, abuse of power or of position, taking advantage of the vulnerability of the person, or, the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal or the sale of organs.

I offer no apologies for the hostile nature of my post as you simply disgust me and I really dont see why anyone gives you the time of day! 

[mallory]

Stauffenberg,  I cannot understand why you think this is right.  If you follow your argument through, it appears that transplantation will become possible only for the privileged in the world.  If we accept marketing organs as a worldwide standard, it will only serve to further exploit people who not only feel they must sell an organ as a means to survive, but those same people will have absolutely no hope of ever having the means to obtain a transplant should the need arise for one in their own lives.

There are huge disparities in global health care now.  I believe the answers lie in finding global solutions to the world's health problems that will benefit people as a whole, rather than benefitting only a privileged few individuals.

[stauffenberg]

If you read R. A. Wolff, et al, "Comparison of Mortality in All Patients on Dialysis," Massachusetts Medical Society, vol. 341, no. 23 (1999), 1725-1730, you will find their statement, right at the beginning, that "the standardized mortality ratio for ... all patients on dialysis was 16.1 per 100 patient-years," which means 16.1% per year.

I wish to thank the poster for confirming my statistical comparison of the dialysis death rate with the death rate in the trenches in World War I, since the death rate of 67.4% which he cites is for the entire war, which lasted from August, 1914, to November, 1918, or 4.3 years.  This works out to a yearly death rate of 15.7%, just as I said.

The fact that dialysis and renal transplant in the Philippines is more expensive than most Filipinos can afford is hardly the fault of the renal transplant patient who receives a new kidney in that country.  It is the fault of the Philippine government for not establishing a free public healthcare system as most countries of the world have, but since the foreign transplant patient does not have a vote in Philippine elections, he can hardly be blamed for the lack of better care for the general public there.

You are right that the transplant donor has to pay for his own future medical expenses out of the $7000 payment he receives.  But keep in mind that many people are born with only one kidney and it is never even noticed until autopsy.  Also don't forget that transplant donors have a normal life expectancy, and are only selected from among people with the highest degree of overall health and especially of renal health.  Finally, medical care in the Philippines is extremely inexpensive.  I spent a half hour talking with a leading transplant surgeon in the Philippines when I was checking out Mitch's program, and the surgeon billed me US $5.00 for the consultation.  I spoke to another infectious disease specialist there who charged me $6.00.  The nephrologist to whom I spoke was more expensive, charging $10.00 for a consultation.

I spoke to several of Mitch's satisfied patients by telephone and also talked to a large number of Filipinos who had bought donor organs through the Philippine system.  I never encountered anyone who was disatisfied with the service or who had had serious post-transplant complications, although it was the custom of Filipinos to wear a surgical mask for an entire month after the transplant, which would not be the usual practice in the West.

Since almost everyone who gets a transplant in the Philippines pays for it, and since transplant hospitals all have standing transplant ethics committees to interview and examine paid donors prior to transplant, I don't understand how what I have seen all over the Philippines with my own two eyes can have been illegal.

If there were a general, worldwide system of paid organ donation for transplants, rather than increasing the exploitation of the poor it would offer an escape for more poor people from a poverty which they regard as worse than having to live with just one kidney.  By definition this is true, since the only people who donate an organ for payment are people who have judged the pluses and minuses of the trade-off and found selling an organ to be to their advantage.  It is arrogant for people in the First World who have generally never experienced such dire poverty to deny poor people in the Third World this option without understanding what this means for them as an escape.

Also, a general, worldwide system in which more prosperous people could buy organs while less prosperous people could not would help rather than harm those not rich enough to buy a kidney, because it would significantly shorten the waiting list for the supply of cadaver organs, which continues to stagnate at the same level it was ten years ago, while the percentage of the population on dialysis continues to grow.

[Rerun]

I agree.  Let the rich buy a kidney and move me up on the list.  Only the rich can buy new Mercedes too.  People are born with two kidneys.  Why not share and get paid for it.  Why give it away.... there is not incentive there.  Oh, yeah you will feel good. 

Personally I think there should be some sort of "payment" for cadaveric donors too.  Funeral Expenses or a tax incentive.  They are usually giving up 2 kidneys, heart, liver, etc.....  And not a dime.  That is robbery.  The Transplant coordinator gets paid, the surgeons get paid, the Nephrologist, Cardiologist, Liver Specialist etc.....they all get paid.  The recipient gets LIFE........the donor gets nothing.  IS THAT RIGHT?  Talk about Exploitation.

No I would not be able to pay $140,000 for a kidney, but those who can....do it and get out of my way on the list.   

[mitchorganbroker]

I have been told by several transplant surgeons that any donor followup is covered
by the recipients Transplant payment. If its entirely un related to the kidney surgery that is
the donors responsibility unless the recipient wants to help.
   I have mentioned on several occasions that to get the donor employment in the recipient's country,
which would provide him with health care , etc , would alleviate all our concerns for his future.
However many Filipinos are happy to stay in their own country.
 
   I was happy to hear from Meadowlands-NJ about that donor survey in India . I will paste a quote.

"The donors were paid 40 rupees (£0.53; $0.83; ¤0.84) for participating in the survey. Ninety five per cent of the men and 60% of the women worked in low paid jobs such as laborers ."
  This Survey is flawed, since the participants were paid and may have told the interviewers what they wanted to hear. But if they admitted working in labor type jobs, that says alot by itself as to their real health status.
   So this may be the way they got the Africans and the Moldavians to come to be participants, down from the hinterland. Paying Africans and Moldavians to "participate" in exchange for money is a flawed, non acceptable survey, not to mention, who spoke Moldavian during the survey .
      Lets see now, a paid Moldavian translator interviewed paid Moldavian participants to tell Organ Watch from Berkley, what they wanted to hear. This poor people were exploited by the survey people who tricked them for pennies. that was an unethical immoral survey , since they present these flawed findings to a sick audience.
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Mike,
       Interesting statistics. You mention that you somehow  know that the transplant is illegal .
       Would you mind backing that up with facts from  Philippine law itself, to enlighten us.

[Zach]

Caveat Emptor (Latin for “Buyer Beware”).

[stauffenberg]

Given the high morbidity and mortality rates among dialysis patients, given the extremely long and unpredictable wait for a cadaver organ, and given the difficulty of getting back into a normal social and psychological state again after a long time on the sidelines with dialysis, let the person who does NOT buy a way out of this trap beware!

[mitchorganbroker]

If only all of the prisoners were like dialysis patients, there wouldn't be any need for guards, because the prisoners themselves would keep themselves locked in, thinking it was unethical to try to escape!   

[angieskidney]

If only all of the prisoners were like dialysis patients, there wouldn't be any need for guards, because the prisoners themselves would keep themselves locked in, thinking it was unethical to try to escape!   

har har very funny but it is NOT like that at all and you KNOW it! We are going by our own personal moral code and experiences which you show you are lacking the knowledge in and you can't just judge us as a group.

[geoffcamp]

If only all of the prisoners were like dialysis patients, there wouldn't be any need for guards, because the prisoners themselves would keep themselves locked in, thinking it was unethical to try to escape!   

What was the purpose of that post Mitch???  Don't be a jackass ok! 
Geoff

[slothluvchunk]

If only all of the prisoners were like dialysis patients, there wouldn't be any need for guards, because the prisoners themselves would keep themselves locked in, thinking it was unethical to try to escape!

Mitch -
Just out of curiosity, how many transplants have you had?

I ask because your statements are filled with ignorance.  Anyone who has ever received a transplant understands that it in NO way "frees" them from the prison they're in.

It's obvious why you're here - not to help people, but to broker deals.  But please in your ignorance, try to be sensitive to the fact that we are real people dealing with real issues.  Many of us here have experienced transplantation, and if you'd look out from under your rock, you'd find a lot of people who've chosen the "prison" of dialysis, over transplant.

Transplantation isn't a cure, it's the trading of one set of problems for another.  To sell it as something else is misleading, and blatantly dishonest.

Forgive me if I've misread something in your post and you haven't meant it to say what I've interpreted it to say.

[angieskidney]

slothluvchunk is right! Mitch you are showing that you know nothing about the side effects of the immunosuppressant medication that is given post transplant so the patient won't lose the kidney transplant. The side effects are many and also the fact that your immune system is lowered to such an extent, even a cold in the first year could very likely make you end up in the hospital. When I had my transplant I was not allowed to go back to school, go to the mall, or any place where there were real life people oh my! Why? Because that is how lowered the immune system is made on purpose just to "be realized from this jail you say dialysis is". Do you actually think a transplant lasts forever? Before you judge people and start name calling please know what you are basing it on okay? With how you are talking you are making me think about changing my mind about letting you be in my own forums. I am sure Epoman is starting to wonder too. Please don't ruin it. You are lucky everyone is giving you a chance. But understand we feel strongly because this is OUR LIFE! We have no choice. YOU DO however.