Transplant Surgery abroad is not the same in every country

[mitchorganbroker]

They can not afford dialysis not do they get government health insurance. Dialysis here costs about $50, more if you don't want to reuse. Some people do get dialysis once in two weeks. There is real dire poverty in most of the world with zero safety net. Here young ladies do die in childbirth at home. This is not Canada or the US.
   The US,Canada and Western Europe have decent health insurance,housing and food programs as well as disability checks for the disabled or the poor. One of my Nephrologist friends volunteers at a special dialysis program in Manila using good equipment donated by the Swedes. Access is free by you need to apply to be considered. Then if you are picked you get one dialysis treatment in a month.
   Half the people live in shacks or sleep on the streets. Children run to beg money from me. To get them to leave me alone, I cover one nostril with my finger, lean over the beggers hand and pretend to shoot snot soup. The shacks have no plumbing and people live very close together. They pirate electric and cable really cheap.
   Many working people get $2/day for a family of 10. Even a Nephrologist would only make 5000/year.
      So to recap, ESRD as well as AIDS are a death sentence here. The local Manila gov. does provide TB medications for free. They have real poverty with little hope so they say 50 cents to buy a lottery ticket.
Anybody want a slum photo ?

[Zach]

Zach, since our whole conversation over the last six webpages has been about the ethics of paid organ donation, I assumed we all understand that the live donors in the Philippines are paid for their donation.  The usage has developed in the medical literature of calling such people 'paid donors,' although technically they are not really 'donating,' since they get paid.  Etymologically this usage may well be justified, since the Latin 'donare,' from which our 'donate' arises, can mean either to 'give' in the sense of 'hand over' something, or to 'give' in the sense of 'make a gift of something.'

This is a perfect example of your twisting what we say to fit your own script.  I quoted Mitch describing them as volunteers.  All you had to do was read what I said, not invent what I said.

You can give us your perfunctory Latin lessons all you want.  I'm just pointing out (with sarcasm) the inconsistencies of Mitch's sales pitch.

[stauffenberg]

Where there cannot possibly be any confusion, there can also logically be no deception.  After seven web pages of discussing the morlaity of people selling a kidney to get themselves out of dire poverty and people buying that organ to get themselves out of even more desperate medical need, if someone says that "he volunteered to sell his kidney" or "he agreed to donate his kidney for $7000," no one in his right mind is going to be confused or misled by these arguably inapt verbal formulations into thinking that we are now talking about altruistic donations.  This type of captious argumentation only distracts us from the real issues under debate.

While there is a surplus of organs available for transplant in the Philippines, local people on dialysis still die for lack of an available kidney for transplant because they cannot afford to pay for a kidney transplant operation or for the donor.  This is not the fault of Mitch or of any foreigners buying up the supply of organs for transplant, since the total number of foreign transplants is small compared to the number of Filipinos who can afford to buy an organ and who do so.  In such a poor country as the Philippines, the supply of people in a population of seventy million eager to sell an organ to escape poverty is enough to provide the whole world of dialysis patients with a kidney and there would still be some left over.

The scene in Philippine dialysis centers is sad, since most patients can only afford to pay for one dialysis session a week, so they don't live very long or look very healthy.  At the center where I was dialyzed in the Philippines, the patients refused to believe I was on dialysis, since I looked so healthy compared to them.  The problem is that even though medical care is inexpensive in the Philippines, it is not cheap enough for the tiny income most Filipinos earn, and medical insurance is almost unheard of, as few people can pay for more than their bare survival from one day to the next, never mind a 'luxury' like protection against medical problems which have not yet materialized.  Also, because President Marcos found enough wealth in the Philippines to ship five billion dollars to his private bank account in Switzerland, and because the profits of the country's great natural resources all go directly into the pockets of the rich Western shareholders whose companies own those resources, there is no money available to establish a national healthcare system to provide free service to the local population.  This is the real exploitation, not the purchasing of kidneys from the local population, in which the money goes directly to the people themselves and pulls them out of a poverty that no one else -- not their government, not the capitalists, and not any rich foreign countries -- are interested in rescuing them from.

[angieskidney]

I think I would have more respect for Mitch if he was the type of guy going around asking for money to help establish some help for the poor on dialysis in the Philippines instead of trying to get us to buy a kidney from the poor who still have kidneys. Especially since there is no guarentee that down the road the donors wouldn't be one of the poor on dialysis themselves.

[stauffenberg]

And I would have more respect for all the doctors in the world if they, like Dr. Albert Schweizer, donated their services all the time to the poor.  But even though very few of them do, that does not make them criminals, untrustworthy, or too suspicious to deal with.

I referred one poster earlier to the medical journal article by Ingela Fehrman-Ekhold, "No Evidence of Accelerated Loss of Kidney Function in Living Kidney Donors," Transplantation, vol. 72, no. 3 (August 16, 2001) 444-449, which convincingly shows that there is no greater likelihood that someone who donates a kidney will later suffer kidney failure himself.  So there is no sense in worrying about that issue.

In fact, generally, living kidney donors are remarkably healthy.  Consider the following analysis by Ronald Munson in "Raising the Dead: Organ Transplants, Ethics, and Society," Oxford University Press, 2002, pp. 120-121:  "The operative mortality of kidney donors is three deaths per 10,000 cases. ... University of Minnesota researchers found serious complications in only 2.8 % of the thousand cases they examined.  They found no deaths. .... University of Alabama researchers were "unable to demonstrate any adverse long-term effects" of kidney donation. ... all available information suggests that the average life-span of donors remains unchanged.  Insurance companies don't even charge donors higher rates for health and life insurance."  Munson is a supporter of payment for live donor organ transplants and, far from being some 'shady character' or 'organ broker' or 'self-interested transplant tourist,' he is Professor of Philosophy of Science and Medicine at the University of Missouri-St. Louis!  So the idea of payment to a donor of a kidney cannot be as outlandish, morally outrageous, or unthinkable as many of the members of this message board seem to believe it is universally accepted to be.

[Sara]

Children run to beg money from me. To get them to leave me alone, I cover one nostril with my finger, lean over the beggers hand and pretend to shoot snot soup.

You're a real class-act, asshole.

[kitkatz]

So why do you not help the Philipinnos who need dialysis by investing in dialysis clinics int he country instead of exploiting them?

[angieskidney]

And I would have more respect for all the doctors in the world if they, like Dr. Albert Schweizer, donated their services all the time to the poor.  But even though very few of them do, that does not make them criminals, untrustworthy, or too suspicious to deal with.

I referred one poster earlier to the medical journal article by Ingela Fehrman-Ekhold, "No Evidence of Accelerated Loss of Kidney Function in Living Kidney Donors," Transplantation, vol. 72, no. 3 (August 16, 2001) 444-449, which convincingly shows that there is no greater likelihood that someone who donates a kidney will later suffer kidney failure himself.  So there is no sense in worrying about that issue.

Then why do the nurses of D&T City seem to think there are reasons to worry? I have heard first hand from medical staff that there are reasons to keep  your "extra" kidney. Liver is different than kidney.

[mitchorganbroker]

Sara, All my Philippine friends caution me not to give money to child beggars, since not only does it teach them bad social-work values, the foreigner seen being nice to the street children here in the Philippines, will be set up,and accused of Pedophilia. So its imperative to get them away from me without touching them. That's an other fact of life here. Sara, when are your Philippine relatives coming for a visit?
Walang pera , deba ?------------------------------------------------------------------------------------------------------------------------------------------
 Angie- I have never charged a Philippine( not counting American-Filipinos) for helping connect him with the best or most economical Surgeon with a good facility as well as the inside information, which I don't share with you guys.
_____________________________________________________________________________
KitKatz- International Dialysis company called Asia Renal Care in the Philippines have opened well equipped ( German Equipment) have opened branches all over the country in the Philippines staffed by Nephrologists 6-7 days a week and lots of RNs, No techs. Still I never had trouble getting a patient an appointment. They always have unfilled chairs because $50 is not available to most ESRD . The American aid does not even trickle down. Some 7th Day adventists come but their help is very limited. The police are very corrupt and poorly paid ( two $ a day) so  any foreigner trying to set up a public aid organization would get ripped off at every step of the way even by the people you are trying to help.I hear this from the local people.
    Many of the older generation admit that they were less poor and better off when America controlled the Philippines as a possession.
So much for Independence.   

[Sara]

Sara, All my Philippine friends caution me not to give money to child beggars, since not only does it teach them bad social-work values, the foreigner seen being nice to the street children here in the Philippines, will be set up,and accused of Pedophilia. So its imperative to get them away from me without touching them. That's an other fact of life here. Sara, when are your Philippine relatives coming for a visit?
Walang pera , deba ?------------------------------------------------------------------------------------------------------------------------------------------
 

We can not afford to pay for airfare plus visas/passports for them to come here.  We do support them as much as we can.  And I don't speak Tagalog or whatever dialect that is, sorry. 

[stauffenberg]

I would refer Angie to the medical journals and to the book by Munson which I quoted, which agree that there is no signficant health risk to the person who sells his spare kidney.  The medical journal articles and studies quoted by Munson are written by professors of medicine and, before they can be published in peer-reviewed scientific journals, have to satisfy a board of experts that they are scientifically accurate.  Information from such sources is more reliable than what some nurse at D & T City thinks she may have heard once upon a time about the importance of having two kidneys.  Generally, the bilaterally symmetric organs of the body (the two hemispheres of the brain, the two eyes, the two lungs, the two testes/ovaries, and the two kidneys) are provided in pairs so that in earlier phases of evolution, when accidents, fights,  and animal bites were a serious problem for human survival, the person could continue living and functioning with just one member of each of the paired organs.  So you can still think with a one-hemisphered brain, you can stil see with just one eye, you can still breathe with just one lung, you can still reproduce with just one testicle or ovary, and you can still survive quite well with just one kidney.  You have two of these things for insurance, not for necessity.l

[meadowlandsnj]

While there is a surplus of organs available for transplant in the Philippines, local people on dialysis still die for lack of an available kidney for transplant because they cannot afford to pay for a kidney transplant operation or for the donor. 


Just a comment and it probably has nothing to do with this but......there seems to be a surplus of dialysis nurses where I go that are Phillipino.  In fact I'd say about 80% of them are.  Most of them (the ones I talk to) have children and families over there and they left them in order to work here in the US.  Anyone else notice this at their center? 

Donna

[mitchorganbroker]

Sara,  the kids laugh and run off when I pretend to do the noes thing. The next time they see me, they smile ,wave but do not stop to beg . That Tagalog expression  walang (no ) pera(money) ,deba ( right !)  You answerred. well.
Most of my friends here are Philippine and they are from the ghetto ( Barangay ) are surprised to see I have windows, running water and junk I hardly use..-----------------------------------------------------------------------
Meadowlans- How do you compare the Philippine Nurses to the American Nurses, in every way   ?

[Rerun]

Donna.  Yes, I have been saying this to my neighbors lately.  Why all the Filipino techs and nurses in the United States?  Are they paid that much less that other races think the pay stinks?  My Filipino neighbor said that Filipino people are hard workers and will work very hard and run and run all day and lazy American's won't.  I couldn't argue.

Correct spelling:  Filipino people live in the Philippines.  Why the F vs the PH??  Don't know, but that is correct.

[mitchorganbroker]

Educated Philippine people try to get a job abroad for a better future. Nursing is the field  where English speakers could get a high paid job in America or Canada , after passing  that countries nursing exams. About 10 % of the Philippine Doctors are going back to school to get a Nursing Degree. The reasons :
    All Philippine Doctors speak fluent English as their second language, since 100 % of medical school , most of university and even three subjects in middle school (math , science and English) are taught in English, unlike Western (continental) Europe.  There is a very hard 3 day American medical exam that needs to be passed to work in the US. I would estimate that only 10 % can  pass it. The average Doctor's salary in the Philippines is $ 5000. /yr.
    Most of those doctors could pass the American Nursing exam and walk into a $ 40,000 to 50,000 Nursing job as an RN. Even Ophthalmologists in the Philippines are throwing in the towel, to go back to school to become a nurse. They say, that there is starting to be a shortage here, of those Ophthalmologists, especially outside of Manila.
    But Nursing school tuition becomes more expensive than Engineer University tuition. It's their supply and demand as well as a more valuable future career.

[Zach]

Mitch has gotten that story exactly right.  A number of nurses, even a couple of techs I have met over the years, were doctors in their home country.  Not only from the Philippines, but from Poland as well.

[mallory]

Here's an article quoting prices for a legitimate kidney transplant in the Philippines as $25,000 (US):

http://www.pcij.org/i-report/2006/medical-tourism.html

The article has links to the Philippine Medical Tourism program:

http://philippinemedicaltourism.info/

If I didn't believe this was exploitation, why would I go through Mitch when I could get the transplant through the PMT program for about a third of the cost?  PMT is very willing to share information, they have all of their contact information on their site.  PMT is a public-private initiative created through an executive order from President Arroyo.  Again, why would I go through Mitch when I can go through PMT?

[geoffcamp]

Good catch Mallory!!!  That is exactly what we all wanted to really see on this thread!  I can't believe how cheap it really is.  Thx for finding these links!  I can't wait to see the responses from mitch and stauffenberg!!

[stauffenberg]

The Philippine people are generally among the nicest in the world.  My wife, who accompanied me on my inspection tour of the transplant system there, commented that it was the only place in the world where you never see people arguing in public.  However, the one limit to their niceness, which is understandable in a country with such desperate poverty, is that they cannot afford to play fair when it comes to money.  Going around in the Philippines and looking like someone from the Western world is like wearing a giant sign proclaiming, "Cheat me!  I'm a foreign millionaire!" which is how the local people see you.  Every price you hear quoted, every deal you think is settled, will be changed at the last minute to your disadvantage, and the Philippine court system is in such a shambles that it takes decades to follow a case to its conclusion.

The result is that if you want to get a kidney in the Philippines, you need the assistance of a facilitator with a lot of local connections who knows how to play the system against itself.  That is the only way you can defend yourself against the local medical system, which will take every penny you have and then some if you don't have an experienced and powerful person on your side to keep them in line.  I learned this lesson the hard way when, in informal conversation with some Philippine surgeons, my wife mentioned something that let them know how much money we had available.  The price we had been discussing with them more than tripled in less than five minutes, being excused by all sorts of imaginary additional costs of which there had been no mention before.  Mitch is worth the price because he is your only lifeguard against these sharks and he guarantees what you can't when dealing with the local system, which is that for the set price agreed upon with him, you get your transplant.  A Philippine system offering transplants for less is just bait to get naive people who are in desperate need and in a vulnerable position -- because they have to rely on the nephrologists offering the transplant also to provide them with dialysis while they are in the Philippines -- to put their neck into the noose of a system that will squeeze many, many times more money out of them than they anticipate.

[geoffcamp]

Oh please stauffenberg!!!!!  Do you think we are morons??  I have negotiated business deals larger then amount we have been talking about here!  And if on the web site article it quotes $25K for the operation the just try and talk me in tripling it!!!  No freaking way that would happen!  I am just as smart as you or Mitch and am fully capable of using my skills and contacting the multiple hospitals they list to find the best deal.  Not only that but I will now have more money to negotiate with without paying Mitch or someone like him.  I think everyone on this forum is fully capable and knows enough about transplantion and would do all the research they could do if they decided this is what they wanted to do.  We are all very experienced in the way of medical cost and patient research.  Your reply holds no water at all!  Simply put we no longer need either of you!  But good try. Good night Irene the party's over thanks!  Way to go Mallory, I applaud you and your research.

[meadowlandsnj]

Meadowlans- How do you compare the Philippine Nurses to the American Nurses, in every way   ?



Very efficient!  I have to say they're very good and know what they're doing.  They speak perfect English.  In terms of caring and compassion they're excellent.  I can't think of one right now who I ever had a problem with.  Another thing is that most of them take on Americanized names.  I had two nurses named Misty and Honey.  They're very clean and hygenic in my dialysis center always washing their hands and using universal precautions. 

[meadowlandsnj]

Mallory thanks for the links to the articles.   

I have a quote from the article:
"Proponents of the medical-tourism program say it could only revitalize the country's weak healthcare system, in large part through outright financial infusions."

Where is the money going?  Back into the system to give the people healthcare? 

[stauffenberg]

Geoff should realize that most business deals he is probably familiar with are negotiated against the background of a society governed by the rule of law, where there is an independent, objective, efficient, functioning judicial system, and honest police force, and a general belief in the validity of contractual agreements.  In the Philippines there is none of this.  As soon as you get off the plane in Manila you suddenly find yourself in a chaotic, bustling, hectic metropolis where you are immediately noticeable to everyone as one of the few 'rich' people in a country where the vast majority of people are desperately poor.  It is a cross between Dodge City of the Old Wild West and the world of Franz Kafka, where nothing is as it seems. 

The closest thing you have in the Philippines to a substitute for the background stability of the rule of law which makes deal-making in the West possible is a service such as Mitch provides.  Unless you have lived half your life in the Philippines as Mitch has, unless you know the local dialects as he does, unless you understand the unique cultural usages which inform every step in Philippine bargain-making, unless you have extensive contacts throughout the medical system so you know from long experience who is a friend and who is not, which people you can trust and whice you can't, then you are going to be completely lost.  I know from my own experience in having explored the world of Philippine transplants for a month.  But don't take my word for it -- why not go there on your own, as I did, and see how far it gets you.

[mitchorganbroker]

Geoffcamp, You remember that  our web site said that prices are subject to change ?
  My boss informed me that the full price is really $85,000. I believe the range given was 35,000 to 85,000. on the web. I am not going to list the web URL but you can ask if interested.
By the way a cadaver transplant with a FREE donor kidney is only 35,000. I did like that photo with the Philippine
water scene. The lady Zoe came for Orthopedic Surgery ,not a transplant. Did you ask yourself , why that news report didn't show a person coming for a transplant ? or even a tummy tuck ?.
     Geoff we do realize how smart you are and you summed up nicely, what you would say if given the real information without a major down payment first. "We don't need you any more " .
 Now I want all you people with telephones to help Geoff find his cheaper transplant, so he doesn't have to eat crow. Don't forget to ask about the donors well being into the future, and morality questions.
  Geoff, when you wake up in AM, make ten or more calls and post something about it by the end of the day.
If somebody in the Philippines says, "for a while sir" and the line goes dead, it means they hung up on you.
    I give the rest of you all longer to tell us , if you have any news about the transplant. Me , I'll go to Makati for lunch and catch up on people watching.
    That news article puts medical services in good light, happy hunting.

[mitchorganbroker]

Meadowlands, You wrote "Where is the money going?  Back into the system to give the people healthcare? "
  No unfortunately, this web is advertising Cosmetic Surgery but uses other news to say it's sponsored by the Government. Read those links and see if it's specific or politicians blowing off air about something general..
   The private Orthopedic Surgery in an expensive Episcopal Hospital can not possibly be a government initiative.
 The money went to the Surgeon and the Hospital, and little if any taxes are paid.