Transplant Surgery abroad is not the same in every country

[AlasdairUK]

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.

So it is either the locals who will rip us off or Mitch who will protect us?

All we have to do is pay Mitch upfront. "and the Philippine court system is in such a shambles that it takes decades to follow a case to its conclusion."

[mallory]

I agree with Geoff on this one.  I am employed by an international company, and I negotiate business deals much larger than this every day for a living.  The price quoted for a kidney transplant in the article is $25K, that gives me a lot of room for negotiation between that price and the $85K Mitch is now quoting.

Should I run into trouble, I would hate to think that I was dependent on Mitch blowing his nose on someone to get me through a difficult situation.   

I think I'll take my chances on my own.  In the unlikely event that I ever end up in the Philippines for a transplant, I'll do my own research and probably go with the PMT program. 

However, Mitch and Stauffenberg, you have shown me one thing; it's not the entire idea of a Philippine kidney transplant that I find exploitative and deplorable, it's you.  It appears you are willing to exploit both the Filipino donors and the kidney recipients. 

Now that's deplorable.

[stauffenberg]

Do you want to know what the 'real price' is for a kidney transplant in the Philippines?  Anything the Philippine surgeons think they can get out of you.  The first price you either hear in person or read on a website is not anywhere near the last price they will demand.  On your own you have no control over how many times or when they increase the price, and believe me, they will, at your most vulnerable moment, such as when they decide that the dialysis center is too crowded for you to have your appointment today or just after you get your epidural and are en route to surgery.  The decisive advantage of dealing with Mitch is that you pay one price determined in advance and then you get your transplant -- no further negotiating, no surprises, no lengthy haggling in a foreign culture where you have no savvy and even less power in the face of surgeons who are holding all the cards while your life depends on their approving your next dialysis treatment.  Mitch acts as your agent to make sure all the otherwise uncontrollable surgeon-sharks stay in line, or otherwise they know he will never refer any more clients to them.  What kind of leverage do you have to get them to stay in line, keep their promises, and adhere to their bargains?  Nothing.  So you can't say Mitch is overcharging, because a) there is no 'real price' for a transplant in the Philippines against which to compare what Mitch charges, since it varies depending on what the locals think they can shake out of you; and b) Mitch clears out of your way many months of unpleasant haggling which will very likely prove fruitless in the end, and instead guarantees you the result you want to buy, so his service is well worth it.

So much for the theory that Mitch is exploiting the patients.  As to the charge that he is exploiting the donors, I have already extensively discussed the reasons why it is not exploitation of poor people to offer them the money they need to get out of poverty.  Are they better off if you deny them the right to sell a kidney and so close the door forever on the poverty trap they are in?  Is it respectful of their autonomous right to choose what solutions to their life's problems which they find preferable, given the desperation of their poverty, if you say, from your position of relative comfort in the prosperous West, no, I don't find it ethical, so I insist that you continue to live with your poverty?  Who is exploiting whom, when a renal patient in a desperate situation, gradually getting sicker and sicker, quickly approaching premature death on dialysis, makes a bargain with a Filipino in a desperate situation, gradually dying from the hunger and disease which poverty will inevitably bring to him, so that each of them can get out of his own desperate trap?  Why isn't the Filipino exploiting the dialysis patient by not giving him a transplant for free, rather than shaking him down for $7000 the dialysis patient may not be able to afford?

[glitter]

just a note-I lived in the Philippines for five years. While far from rich-it being a third world country we WERE compared to most of them. if you go to the downtown market you pay someone(they cluster around you) to watch your car(or you won't have one) carry your basket and sometimes a guide. then when all the postions are filled the others look for the next mark.It is tragic but its also just a way of life there-I was treated wonderfully always by the Filipinos.and i loved living there-but to go there on your own without hiring a guide would be foolish-I'm sure there are others besides Mitch who would guide you for less-but it is risky regardless and naive to think your good intentions mean anything to them.

[mitchorganbroker]

Do you trust American Lawyers ? We have already suggested to Geoff, the details on this thread using two lawyers and a contract .
One lawyer is American who you pick (and pay)from any US city you like. We pick one over here.
  Our payment if you agree in the end is to a bank in the US, with an American address.
If any of you have ever been here, you know they don't take American checks.
Do you want to be guided by a Philippine guy on the corner or a professional group that is wise enough to Bank in the USA.?

[mitchorganbroker]

MEDICAL TOURISM NEVER DOES TRANSPLANTS. The newspaper said the Philippine President favors Medical tourism but she doesn't want foreigners coming for live transplants otherwise American aid would be cut.
I will look for the article where she concurred with the US Dept of State against Transplants.
    Further the Tourism group didn't list transplants as a service provided. The mention of a Transplant for $ 25,000. is with student Doctors in training at a Government Hospital for a cadaver donor, which is one Surgery, not two as in a Live donor. Even that price doubled as in two people having Surgery , plus the American trained Surgeons fee, not included above, plus the live donor, brings the price to triple.
   If I am proved wrong after you contact Mallory's post, please tell me.

[geoffcamp]

Mitch,  I am not willing to do any legwork on this for a couple of reasons.  1.  I do not want to jeopardize my current bid for an American transplant (getting my medical records and such would be a red flag!)  2. I simply do not have the time or energy to do the work involved as I am working more then full-time and doing dialysis.  3.  I am not currently in a life or death situation.  Dialysis is working fine for me and has for 6 years now.  Now if I was n a life or death situation I do believe I would seriously consider trying this route.  I can definitely understand why people needing liver transplants would find this a viable option as there is no treatment and they will die if a liver cannot be procured.  As for using you or someone like you I think I would at least give it a shot on my own.  Hire an interpretor and do most of my negotiation from the states and have everything all ready for when I arrived.  I am suspicious of the offers on the those sites as well as yours, I have found the being suspicious is a healthy approach to anything that is this complicated and looks too good to be true.  It is just the way I am.  I am sorry i really would like to make some calls and find out more but I do not want to jeopardize what is going on in my bid for transplant now.  I am intrigued by this method and maybe someday it will become a more "above the board" effort.  Let's hope that continued work on new options such as this will pave the way for more transplant options to those of us who want/need them.  Maybe insurance companies will push these options to save money for their greedy bottom lines and the US government will look to these programs to more effectively come up with living donors in the states in the future (thru compensation of some sort to willing living donors).  Options are never a bad thing however i would feel a lot more comfortable if there was a legal way of doing this.  Also a way that would guarantee that your medicare and private insurance will cover the costs of post transplantation when you arrived back in the states after transplantation.  Just my opinion.. there are pluses and minuses and it is a start to open the eyes of the "majority" to find new ways of making living donor transplantation more prevalent and find a win win situation between commerce and heath care.  I am sure we all want options and no one wants to die waiting for an organ we all have a lot to live for!  But right now we simply are not in a place where this seems to be a good alternative to someone like me.  I hope you decide to find a way to make the "system" as a whole better and give hope to the people who desperately need organs because the alternative is scary!  Hopefully there can be a change for the better and all can benefit from some kind of hybrid programs that should be looked into and developed.  That is my wish.. a better way! 
Geoff

[stauffenberg]

Believe me, absolutely the last thing on earth the plantation masters of the U.S. dialysis system are ever going to suspect is that one of their 'slaves' is going to escape their control by buying an organ from a live donor abroad!  There are a thousand stories you can tell them so that there is no 'red flag' problem, such as, for example, just saying that you are going to be away for a while and the general practitioner you are going to speak to there wants you to bring your medical records with you.  It is also possible to go to the Philippines with no medical records at all, since the hospitals there do all their own diagnostic work and tissue-typing just to double-check in any case.

Staying on dialysis is never harmless, since it some damage is always accumulating given the fact that dialysis only compensates for 10% normal renal function (G. M. Danovitch, "Handbook of Kidney Transplantation (2001), p. 1).  These may remain sub-clinical for several years, but by the time the harm from continuing dialysis appears, it is often too late to correct it.  Thus in my case, I had absolutely no clinically evident complications of dialysis for seven years, but then, suddenly, several appeared all at once, such as weakening of the heart muscle, deformation of the bones in my foot from dialysis neuropathy, and a general hormonal imbalance because of toxic effects on the pituitary gland.  I will now always walk with a slight limp because I did not get out of the dialysis trap quickly enough, but I was lucky not to be among the many who suffered amputation, heart attacks, or cancer from spending too long on the machine.

[Zach]

Believe me, absolutely the last thing on earth the plantation masters of the U.S. dialysis system are ever going to suspect is that one of their 'slaves' is going to escape their control by buying an organ from a live donor abroad!

Man, take a deep breath!
We're not slaves.

You really need alprazolam.

[AlasdairUK]

Stauffenberg why are you trying to sell the organs so badly? I understand that Mitch gets money out of it. What do you get?

I know you are trying to argue your point as you went there to buy a kidney and subsequently have had a kidney transplant. What country did that happen in?

I just see the world a little differently to you. We all do what makes us happy. I feel fortunate enough to be able to have dialysis as many people around the world are not so lucky. If that makes me a slave I will take that title.

[stauffenberg]

I think the characterization of the whole dialysis-transplant system in the West as a 'plantation,' and of the patients as 'slaves,' is an apt one.  Companies like Fresenius, Baxter, and Kaiser make a fortune out of their truly 'captive' population always having to pump money out of the government into the companies' pockets.  Nephrologists, dialysis nurses, and technical support people are also making money off of the perpetual plight of the patients.  The dialysis centers themselves are often run mainly for the convenience of the staff, while the patients are forced to endure countless petty rules which, not being objectively necessary, in fact merely serve the psychological point of keeping patients subservient. 

The transplant system as well is not run with patients' priorities in mind, but is severely limited by the utter disinterest of the general public, which ultimately determines what government transplant programs are going to be, in rescuing patients.  The supply of transplants is also unreasonably limited by a public policy which bends over backwards to invent arbitrary 'ethical' rules which prohibit transplants on one flimsy pretext or another.  Many countries refuse to allow altruistic donors to provide an organ because they are so idealistic they are suspect, and at the same time, they refuse to allow paid donors because they are not idealistic enough.  Some countries used to ban relatives from donating because they were thought to be under too much pressure from the patient and so could not make a valid decision, while now these same countries ONLY allow relatives to donate because ANY ONE ELSE is assumed to be  under too much pressure to make a valid decision.  In most countries where the law says that a person can donate his body for transplant, physicians still, in defiance of the law, permit the relatives to override the wishes of the deceased, because they consider the right of relatives to feed the worms in the cemetery to be ethically superior to the right of the deceased to determine how his own body is disposed of and the right of the waiting dialysis patient to get a life-saving organ.  The whole system is cruel and idiotic -- just like the treatment of slaves in the plantation system of the American South.  Most dialysis nurses I asked confessed they had never even thought of signing an organ donor card -- which gives you an idea of the contempt the plantation masters have for their slaves.

That is why I am so passionate about helping the slaves out of their confinement, like a modern-day Sparticus, especially since I was once trapped in the plantation system myself.  If the only quick way out today is the admittedly imperfect one of getting a transplant through facilitators like Mitch in the Phillippines, then I say we have every right to take that route unless and until the Western dialysis and transplant system is radically redesigned to put the patients' needs first.

[angieskidney]

Why the hell do we have to go all the way to the Philippines when there are North American sites like:

matchingdonors

or even FREE places to advertise for donors and dialysis patients in need right at D&T City??

Just read this CBSNEWS article.


** please note that no one here particularly pushes these sites, but they are ones I have come across in the last year during my research on this topic.**

So tell me, WHY do we have to leave our countries?  We don't have to pay someone for a kidney when there are generous people who give from their hearts! (I still worry they are not properly educated on what it means to give a kidney but still we don't have to pay)!!

[stauffenberg]

The first problem with Matching Donors is that it may take quite a while for someone to step forward to help your particular case, especially if you are not cute or if you can't tell a heart-warming story about why someone should help you as opposed to some more moprally appealing young person  in need.  Also, there are many stories about volunteer donors backing out at the last minute, as the whole project suddenly begins to seem uncomfortably real to them.

But the most important reason is that many transplant centers in the U.S., and nearly all transplant centers in Canada, absolutely refuse to consider performing transplants on altruistic, unrelated donors, because they presumptively assume that they must be being paid, and try as you might, you can never convince them otherwise.

[angieskidney]

OKay that that brings up another important point!!

How do you decide who gets a kidney from someone first before another?? Do you know who needs one more?? Someone who gets a kidney real fast won't appreciate their situation as much as someone who waits for a transplant.

Don't get mad at me anyone! I am ONLY speaking from my OWN personal experience!

[waitlisted]

Why the hell do we have to go all the way to the Philippines when there are North American sites like:

matchingdonors

Does anyone here have any experience about matchingdonors?

But the most important reason is that many transplant centers in the U.S., and nearly all transplant centers in Canada, absolutely refuse to consider performing transplants on altruistic, unrelated donors, because they presumptively assume that they must be being paid, and try as you might, you can never convince them otherwise.

Is this really true? At least in my center I was very much encouraged for living donors and I was recommended to "talk to family, friends and workplace colleagues and have them call us".

Someone who gets a kidney real fast won't appreciate their situation as much as someone who waits for a transplant.

This might be true in some cases, but I don't think we can generalize that people getting fast transplant would not be appreciative. Also my neurologist's opinion was to try to get to the list asap and hopefully avoid the dialysis totally. I have heard the same opinion from other nephrologists as well. (Of course I understand that this not possible if you have acute renal failure, but can work only if you have a slowly progressing CKD.)

[Zach]

But the most important reason is that many transplant centers in the U.S., and nearly all transplant centers in Canada, absolutely refuse to consider performing transplants on altruistic, unrelated donors, because they presumptively assume that they must be being paid, and try as you might, you can never convince them otherwise.

Is this really true? At least in my center I was very much encouraged for living donors and I was recommended to "talk to family, friends and workplace colleagues and have them call us".

Once again, staffenberg has it wrong.  Many centers today in the U.S.A. do encourage living non-related donors.  In fact, I know one major transplant center that advertises on the radio the use of living non-related donors.

[mitchorganbroker]

Medical Tourism says you need to bring your own related kidney donor and says it costs 3 million peso,( $60,000.not counting the donor))( not $25,000)  Read below from Philippine newspaper. 

"Editor's Note: Published on page A1 of the Jan. 5, 2006 issue of the Philippine Daily Inquirer
A NEW KIDNEY would save an Arab man's life so he went to the Philippines. Not as urgent, an American girl wanting bigger breasts arrived here, too. So did a Korean girl who wanted her eyes bigger and more expressive.
Driven by different medical reasons, foreigners like them have been steadily coming to the country as part of the Philippine Medical Tourism Program started just two years ago.
They come mainly because treatment is much cheaper here than in their respective countries like the United States, according to Undersecretary Jade del Mundo, the Department of Health's pointman on the new program.
Visitors usually seek cosmetic procedures which are mainly available at the Belo Medical Center and Calayan Service Center.
Both clinics fall under the "ambulatory centers" included in the program. They also include the American Eye Center, Asian Eye Institute, and RX Pinoy, a group of doctors involved in medical tourism.
Del Mundo said Asian


Kidney donor
Since available kidneys are scarce in the country, foreign patients are asked to "bring your own kidney donor" who is usually a relative or a close friend, according to the undersecretary.
"We don't want Filipinos to be sacrificed in favor of medical tourism," he said.
rer


Editor's Note: Published on page A10 of the January 17, 2006 issue of the Philippine Daily Inquirer
the competent health professionals it has, its international image as a caring and compassionate nation and its very reasonable and competitive medical rates. Also a plus is the fact  that most of our health professionals are proficient in English.
A heart bypass here costs only about P500,000, or about half the price abroad. A kidney transplant costs P3 million,The Philippin or less than half the rate in other Asian or Western countries. Even cosmetic surgical procedures are cheaper here. For example, blepharoplasty, which widens the contours of Asian eyes, would cost about P500,000 in Japan and South Korea, but only P150,000 in the Philippines."
_________________________________________________________________________________________________________----
  In the Philippines due to the Hurricane our electricity has been out three days, since falling trees have knocked power lines.The hospitals have backup generators, so the dialysis center there is OK, but many dialysis centers outside of hospitals do not have backup generators.
Since I crave Air conditioning by mid day and miss the Internet, I just walked in to an expensive hotel since I don't look like a Philippine but like a tourist. Now that I stopped sweating and wheezing, I feel better. They say we may get the electric back by Monday some time.
   This blackout has hit the main  Island of Luzon, including Manila. Its much worse on the poor Philippine people from the slums, than myself since my building lights the hallways and runs the elevator with the generator. I use candles and now just chilling for free in a Hotel lobby. The big stores and supermarkets use generators for lighting and cooling food, but no more air conditioning. Cold water showers still help cool people down

[stauffenberg]

Zach, of course you must realize that there is no logical inconsistency between my saying that "many" U.S. transplant centers will not accept unrelated, altruistic donors, and your saying that "many" will.  I don't know if anyone has yet published a tally of the numbers of each type.  But the general problem is that the medical profession, under their motto of "First, do no harm," has a strong bias AGAINST accepting a kidney donor, and thus positively struggles to find some reason during the intensive interviews of the donor they conduct for NOT allowing the donation to proceed.  Even if a related donor at the last minute suddenly says anything that could be construed to suggest that he is less than 100% enthusiastic, the doctors will even lie to the patient, telling him the potetial donor had a medical excuse he did not in fact have, just to save the donor's shame at backing out. With a paid donor in the Philippines all this hassle and uncertainty is avoided.

In Canada unrelated, altruistic donors are almost never accepted.  In fact, last summer there was a legal case, Tengue v. Royal Victoria Hospital of Montreal, of a dialysis patient who had an altruistic but unrelated donor whom the hospital simply refused even to interview, saying it was against there policy to accept such donors.  He sued them for violating his right to life, and as the crisis built and the media pressure was on, suddenly, miraculously, "just the right cadaver kidney became available" for Tengue and the suit was dropped.  Obviously the hospital did not want to see its cherished anti-patient policy struct down by the court as the foul violation of human rights that it was.

In England there is a national committe which reviews all unrealted, altruistic donors to make sure that there is no possible excuse, real or imaginary, they can find to disqualify him.  The committee feels good about itself and morally superior every time it condemns another patient to a slow death on the machine in the name of its own, ignorant ethical presuppositions.  The chances of getting a donor over that hurdle are small.

[Zach]

Zach, of course you must realize that there is no logical inconsistency between my saying that "many" U.S. transplant centers will not accept unrelated, altruistic donors, and your saying that "many" will.

Yes, I chose the word "many" precisely for that reason.
It's all about how one sees the world around them ... half full or half empty.

I would also like to add that the word "most" will soon replace the word "many" when it comes to, " ... transplant centers today in the U.S.A. do encourage living non-related donors."

[mitchorganbroker]

Zach , the bottom line is that the shortage of transplant organs in the US keeps getting bigger. Unos has the American stats, see www.unos.org All the efforts of Education and all the other American half way measures did not reverse the trend.The glass is becoming more empty than half. .
   Me personally, I am content the  US keeps coming up with moral ,ethical or other silliness as to why they don't legalize paid donors. Many people on this forum howled that those in the Philippines were immoral and questioned if we had the brains to inform the donors of the risks.
    But when they thought "a Medical Tourism Program" would do a transplant for $25,000., all that moral B.S. went out the window.
That gloating was short lived, when new post  showed Philippine Daily Inquirer, wrote the Under secretary Del Mundo head of Medical Tourism says you need to bring your own related kidney donor and says it costs 3 million peso,( $60,000.not counting the donor))( not $25,000) 
    Geoff , when you call you will not need a translator because any worker who answers phones needed to be fluent in English to get that job. Mallory, this is my followup on your posting on Medical Tourism.
     Well, our Philippine electricity is still out

[kitkatz]

It is very scary to look at a country for possible transplant that has a power outage and cannot get up and running again in a few days. I think the major cons of going to the Philippines is that there is lack of technology throughout the country as a whole.  I would worry once I was out of the hospital would I be able to eat good food and drink water that I could survive on.  As often happens to foreigners in countries, they get sick on the water and food because their system is not used to it.  It would be very expensive to do bottled water and import food.  You are asking very westernized people to come to a country we know little about and have major surgery.  Personally I think it is nuts.

[stauffenberg]

As a Westerner, you can completely insulate yourself in a first-world cocoon in the hotels, and all the hospitals have their own power generators.  If you are afraid of Philippine food, there is a McDonald's restaurant on every corner, although they generally serve rice instead of french fries, which is probably more healthy for you anyway.  Finally, if you are afriad of the cultural adjustment, that is why you pay a facilitator like Mitch to handle all the bureaucracy and negotiating for you.

[AlasdairUK]

I'm in the UK and they do allow ultrustic donors. I have had 8 people go for tissue typing and only 1 one is a relative. I feel the dialysis unit is only there because of patients like me. It must be run differently to the States as the only people who could make money out of it is who ever supplies the stock to run the dialysis machines. I don't feel as though I'm a slave to the centre. I might be a slave to kidney failure, but that I will have to live with that for the rest of my life regardless if I have a transplant which I have or if it is on dialysis.

While I agree a transplant is a better form of treatment it is by far not a cure and gives you another form risks. I do not think this is the debate.

My concern is buying Body parts in an unregulated fashion. To me this would create slavery where people are so desperate for money that they have to sell of a body part. How can you say there is no duress when someone is so desperate for money. They might not be forced into donating by another person, but forced into it by circumstance and I'm sure brokers will target these individuals and sell them the dream. How many kidney sellers get themselves out of poverty by selling one of their kidneys?

In an ideal world I would not be against buying a kidney if it was State controlled. Where the State would buy kidneys from the public on a voluntary manner and then send them to the transplant centre that had the best patient match as they do with cadevaric organs. In theory the State would be able to pay for the cost of donors from the money it saves against dialysis costs. I did say an ideal world.

Unfortunately for me brokers do not fall into this category of an ideal world.

[meadowlandsnj]

Say I arranged for a kidney transplant through Mitch.  Everything is arranged, I'm at the hospital and ready to do it.  My donor gets scared and backs out at the last minute.  Is he coerced into doing it after that?  What happens then?  Do I get my money back?  Has it ever happened like that where the donor changes his mind?  I know when I had my donation from my mother in 1995 I told her right before she went into the OR that she can change her mind anytime and it would be fine with me.  I can't imagine a donor doing this when the organ is already bought and paid for. 

[stauffenberg]

Alisdair, I began dialysis in 1996 in England and was dialized at four different centers during my time there.  My typical experience as a dialysis out-patient was that I had to wait at least 45 minutes for my treatment session, since the staff insisted that the patients arrived on time but did not return the courtesy by being punctual for our needs as well.  The dialysis room had one loud, blaring television set bolted to the ceiling for thirty treatment stations, and there was no way to change the channel.  The dialysis machines themselves were so old and contained so many bio-incompatible elements that I always vomited after each treatment in the taxi ride home.  Instead of the nephrologists coming around to see the patients during treatment as they usually do in North America so as to save the patients' already much-reduced free time, the nephrologists made us come to their clinic, where we also had to wait hours, in addition to the three treatments a week.  I never felt as if the NHS or the British taxpayer cared a whit whether we patients lived or died.  Even when I was in three of the 'leading' hospitals of London when I first developed renal failure, I was so much  ignored by the doctors that my hemoglobin feel to 60 simply because no one ever bothered to check it, since I was classified for four months as an 'acute' renal patient, and that class of patients normally gets well in a week or two so there is no need to give Epo or to check hemoglobin levels.  In short, I was treated like dirt.

Although England at least has enough moral sense not to let private, profit-making companies deliver dialysis treatments, there are plenty of people making money even there from the fact that patients are left to languish and die on dialysis, from the dialysis equipment suppliers to the surplus nephrologists.

As for the morality of buying a kidney for a poor person, why do you assume that a bargain which a poor person finds profitable to him to accept necessarily has to be illegitimate?  How do we harm people who because of their extreme poverty will die early, suffer poor health, perhaps starve, have miserable facilities in which to live, and be unable to provide for their families if we deny them the only way out of the trap they are in by calling it, from our position of material comfort in the West, 'morally unacceptable'?  The $7000 Philippine kidney donors get provides them with the money to send their children to school, pay off their mortgage, and open a small shop for themselves where they can guarantee themselves employment for the rest of their lives in a country where the unemployment rate is 25%.  Is that bargain exploitative if the person accepting it voluntarily is of the view that it is to his benefit?

Meadlowlands should keep in mind that before the transplant operation is scheduled the donor has had to pass through a lengthy interview with the hospital ethical commission in the Philippines, in which a priest, a nephrologist, and a psychiatrist rigorously scrutinize the donor to determine that he is acting of his own free will and without any mental reservation.  This considerably reduces the chance that he will back out at the last moment.  If he does back out (and I have never heard of it happening), there are long lines of donors waiting already to take his place.  Of course there would be a delay while the new donor was tested and interviewed, but in a week or two the surgery would go ahead as arranged.  If for some reason the surgery could not proceed, such as no donor being found who was a suitable HLA match or able to pass the crossmatching test, then Mitch would refund the money paid, minus the dialysis and medical testing costs up to that point.  This would mean that the major costs, such as the surgery, the donor's fee, and most of the hospital bill would not be owing.  At least that is what I understand about his policy -- for the details you would have to ask Mitch himself.