Transplant Surgery abroad is not the same in every country

[angieskidney]

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,

Do you blame them? I mean I know a lot of nurses since I moderate a forum run by U.S. Dialysis Nurses. I have heard first hand (and so has Mitch from Dialysis Joe, who is the main nurse who runs D&T City) from nurses who say they took an oath to help as long as they do not harm a living being. They will not just take a kidney from one to put in another if it will lead to any harm to the donor. They want to make sure the donor knows full well what s/he is doing and what their future will mean without their "extra" kidney.

But instead you are playing on the side of guilt and anger trying to make like you are our buddy against the evil nurses and doctors who won't give us a chance at a real life!

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.

EXACTLY!!! 

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.....

You know ... you love to describe dialysis as this unbarable torture and that we should all be in a major rush to get a kidney from anyone and who cares about the donor as long as they go through with it.

Dialysis for me is nothing like you describe! WE all have headphones for our tv's and we all have remote controls at my unit and we all have Fresenius 2008K machines and have never had any trouble with comtaminations. Even my taxi has worked out a system with me and my favourite cab driver and I sing to the radio on the way home And the longest I ever had to wait was once 1/2 hr. All the other times only 10 min max. Waiting in the Nephrologists office after you get a transplant is a longer wait than any dialysis day wait.

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?

Why do you think that if you are rich that morals don't matter? No matter how much money I have or lack I have my own morals that don't change with what my yearly income is!

And to anyone who says that no doctor will let any live person donate a kidney to someone if they are not a relative, read the cbsnews link I posted above again because obviously you didn't realize that was in the States. There was complete stranger who donated a kidney to another who he never met! It DOES happen! You make it sound like it never does!

[mitchorganbroker]

Kitkatz, Most apartment buildings had backup generators for at least the elevators and hallway lights, but ALL the hotels costing at least $15/day had ice cold air conditioning as did all the major hospitals. The electric powered trains were running as well as all public transport in Manila during the 4 day blackout with the help of gas powered generators. The big stores , supermarkets and restaurants were not as icy cold as before the black out but felt OK for me to be there. But the slums had zero electric. My impression as to why the repair crews didn't get it repaired quicker, is that the repair people were not asked to work overtime, so the company could save money. The government wasn't offering to pay the overtime and the slum dwelling weren't real customers anyway, since they are part of the network that cuts in to the main line for free.
    So for the TRANSPLANT patients in the Philippines, everything was normal.
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Meadowlands-  You asked," if 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? ".  
 The Doctors have a big list of donors ( no brokers here) so he would fill it quickly ,however the donor wants to get the financial help so badly, this would not happen,and never did.  Yes you get your money back, minus the already used tests, dialysis, meds and the Nephrologist medical evaluation.
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AlasdairUK- I think a transplant is a cure to ESRD, since this disease is no longer in the patient.
  You said " 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? "  
   You seem to think that "brokers", who don't really exist will target the very poor ( 74 million people out of a population of 75 million).  These poor people know very well ,without being tricked by a fantom character ,that the sure way to make big money is to sell an extra kidney, so they flock to the hospitals to beg to be a donor. The amount should get them out of poverty however better still would be for that concerned British person to get him a job in the UK, to keep an eye on the chap, as well as signing his UK VISA application and flying him to Heathrow. Then after 6 months or so of working in UK, he gets to have his own British Health System to cover his health needs.

[angieskidney]

- I think a transplant is a cure to ESRD, since this disease is no longer in the patient.

How can you say, "this disease is no longer in the patient" I mean ... do you think that the body does NOT fight off the kidney? What do you think the antirejection medication is for? Fun candy??

Transplants do not last forever as the body's natural defense fights it off! If it is a CURE then why don't I still have my transplant??  And the fact that I am BACK on dialysis after I had a transplant ... if "this disease in no longer in the patient" then what is this I have now? A NEW DISEASE???

The amount should get them out of poverty however better still would be for that concerned British person to get him a job in the UK, to keep an eye on the chap, as well as signing his UK VISA application and flying him to Heathrow. Then after 6 months or so of working in UK, he gets to have his own British Health System to cover his health needs.

It seems like MAYBE they flock to you because you advertise that they can get free health care or get a better future in OUR countries ?? Is that what you are REALLY  telling them??

[sandman]

Transplants do not last forever as the body's natural defense fights it off! If it is a CURE then why don't I still have my transplant??  And the fact that I am BACK on dialysis after I had a transplant ... if "this disease in no longer in the patient" then what is this I have now? A NEW DISEASE???

That is a very good argument Angie.  I couldn't have worded that any better.  Well how about it mitch?  How do you explain this?

[AlasdairUK]

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.

Stauffenberg I'm sorry you had such a poor time. I have once had to wait an hour, but I do not have to have an arrival time. I do twilight shifts and they are happy for me to arrive when I can. Obviously I get there as early as I can so I can get home as soon as I can. If I do have to wait it does not bother me as much as it must you as I think what is the difference between 4 hours or 5 hours. My concern is to achieve a good dialysis. That is my main aim. I use a Fresenius 5008. In the UK you are able to choose which hospital you want, so you have the freedom to move. I agree that not everything is perfect, but you do need your glass to be half full.

AlasdairUK- I think a transplant is a cure to ESRD, since this disease is no longer in the patient. Have you had a transplant? I have and yet I still have kidney failure.

You seem to think that "brokers", who don't really exist. I do think they exist, they just do not fit into my ideal world.

 The amount should get them out of poverty. My question was how many kidney sellers actually get themselves out of poverty. I'm sure in the short run the cash injection is beneficial, but what are the long term effects?

I'm not sure of letting in 74 million poor people into a country that has a population of about 65 million is a realistic approach. We do however have an open policy within Europe and with the EU expanding some of the poorer EU states are allowed to come and seek work in the UK and receive benefits. However most come and add to the economy with working hard, paying taxes. I think we are getting off track here as this is not an immigration debate.

[stauffenberg]

In theory a transplant is not a cure for endstage renal failure, but is instead just another mode of treatment, like dialysis, since a foreign kidney maintained in an unnatural location in the body by immunosuppressive drugs is not a natural condition, but an ongoing medical intervention.  However, in terms of the way the patient feels and lives while the donor organ lasts -- which can easily be 20 years from the kind of young, carefully selected, well matched kidney you can obtain from a live donor in the Philippines -- life with a transplant is FUNCTIONALLY EQUIVALENT to perfectly healthy life.  Having to remember to take a handful of pills morning and evening and having to visit the doctor every few months represents a trivial difference between normal human existence and the existence of a transplant patient, but is miniscule compared to the difference from the normal standard of the life of a dialysis patient.

Angie, with respect to the ethical position of physicians always favoring the donor's interests over the potential recipients, I do not think this is consistent with the Hippocratic rule, "First do no harm."  Just look at the issue in utilitarian terms:  if you have one patient dying of renal failure and another person with two healthy kidneys, the total human happiness between the two of them is infinitely smaller than the total human happiness in the same pair if you have one person with a functioning transplanted kidney and the other with a functioning natural kidney after the transplant.  So doctors ARE DOING HARM every time they concoct some 'ethical' reason for NOT accepting a donor, since they reduce the total amount of human happiness in the world!

I have been dialyzed in four different countries, and the experience in each place was very different, but England was for me one of the worst.  I agree with you that dialysis in most places is not as bad as in the center I was describing, which was the outpatient dialysis clinic of the Hammersmith Hospital in London.

I also agree with you, Angie, that live, unrelated, altruistic kidney donors are accepted in many transplant centers in the United States and also with the approval of the central committee for such donations in England.  But almost nowhere in Canada is this possible, and many centers in the U.S. will also not consider it.  It all depends on how stubborn and old-fashioned the nephrologists are where you are being treated.  But do you think it is ethical that the stubborn, unreasonable, personal value system of some ignorant transplant coordinator should be allowed to determine which dialysis patients live and which die -- which is what happens when they reject unrelated altruistic donors.

Alisdair, Mitch is right when he says there are no kidney brokers in the Philippines, much as those who oppose the sale of spare kidneys love to conjure up the image of the evil broker.  The system actually functions by transplant facilitators like Mitch bringing overseas patients into contact with the Philippine surgeons and transplant hospitals where they can be transplanted.  The facilitator makes all the arrangements and guarantees all the prices, but he never deals with any Filipinos selling their kidneys.  Instead, it is the Philippine surgeons themselves who, independently of the facilitators, recruit and test potential donors from the local population, maintaining a large list of blood types and HLA antigen date so they can easily match patients with donors when and as the need arises.  In one case I saw a surgeon would perform a kidney transplant on a poor Filipino for free but then in return the patient would have to go back to his village, tell people about the possiblity of donation for payment, and then recruit them to be tissue-typed.  So the transplant facilitator is quite far removed from anything that can be described as 'organ brokering.'

[Zach]

In theory a transplant is not a cure for endstage renal failure, but is instead just another mode of treatment, like dialysis, since a foreign kidney maintained in an unnatural location in the body by immunosuppressive drugs is not a natural condition, but an ongoing medical intervention.  However, in terms of the way the patient feels and lives while the donor organ lasts -- which can easily be 20 years from the kind of young, carefully selected, well matched kidney you can obtain from a live donor in the Philippines -- life with a transplant is FUNCTIONALLY EQUIVALENT to perfectly healthy life. 

Yes, the transplanted organ "can easily last 20 years," or it can easily last only 4 years, even "from the kind of young, carefully selected, well matched kidney you can obtain from a live donor."  Please take the time to read the transplant stories of the members here.  Some have had two and three kidney transplants.

And there are kidney diseases that do, in fact, reoccur with the transplanted kidney, such as Focal Segmental Glomerulosclerosis (FSGS) and Membranoproliferative glomerulonephritis (MPGN), to name only a couple.

You have had your transplant for only about 18 months, right?  Do you think the kidney works fine for whatever number of years and then just stops?  It is usually a slow progression to failure.  And during that time, perhaps over two years, you will feel pretty bad, both physically and emotionally ... and more than likely spend a whole lot of time in the hospital.

Having to remember to take a handful of pills morning and evening and having to visit the doctor every few months represents a trivial difference between normal human existence and the existence of a transplant patient, but is miniscule compared to the difference from the normal standard of the life of a dialysis patient.

Since you have been telling us that we are slaves to the dialysis industry, you mean you're not a slave to the medications and big Pharma?

And going through life with a compromised immune system is no fun and games.  As you yourself have stated before:

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.

And for most transplant patients, there is a real concern of skin cancer, including Kaposi's sarcoma.  In fact, according to the November 2005 issue of Cancer Online, "kidney transplant patients can be up to four times more likely to get melanoma, a deadly for of skin cancer."  So much for your "life with a transplant is FUNCTIONALLY EQUIVALENT to perfectly healthy life."

Lets get real, folks!       

[mallory]

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) 
   

Mitch,  All that "moral B.S." did not go out the window, you and Stauffenberg appear to refuse to consider that we have morals or that they are of any consequence to this issue.  I have stated repeatedly that I have no intention of ever going to the Philippines for a transplant, that is still true.  I don't think it's the right thing to do, not through you, and not through the medical tourism program.  Here is a link to an article describing medical tourism in the Philippines as a "poison pill" that is hastening the demise of the public health care system in the Philippines:

http://www.manilastandardtoday.com/?page=politics03_feb11_2006

I think the issue of organ transplantation is an emotionally-charged minefield, and there are a lot of things to consider for both the donors and the recipients.  Each of us who are faced with those decisions have to make choices based on our backgrounds, morals, financial status, cultural mores, familial opinions, religions, physical condition and many other factors.  

Stauffenberg, I'm glad that having a transplant, wherever you got it, worked out for you.  If you did get your transplant in the Philippines, it sounds like you are pleased with your decision.  I think that's great.  Please allow us the same consideration.  For many of us, the idea of a Philippine transplant is not acceptable, and we have a right to our opinions, just as you do.  

As to whether Mitch is a facilitator or a broker, why do you care what we call him?  Because "broker" has a negative connotation?  Because it makes him sound like his motives are less than altruistic?  Come on, let's call 'em like we see 'em; in my opinion he's a pimp.

[angieskidney]

  WOW VERY GOOD ARTICLE!! 

In 2004, the Philippine Heart Center (PHC) had as many as 4,000 patients waiting for heart surgery. At the National Kidney and Transplant Institute (NKTI), there are over 180 patients in the waiting list for kidney transplants.

Many of these patients may die even before they get the treatment they need.

“What happens to these patients when PHC and NKTI open up their doors to foreign patients?" he asked.

He pointed out that heart surgeries and kidney transplants are also expensive for most Filipinos. A kidney transplant will cost a paying

patient between P1million and P1.5 million while a charity patient will have to shell out almost P500,000 even if the kidneys are donated for free. But rather than act to make these procedures more affordable, government agencies are now advertising these procedures as “cheaper” alternatives for foreigners.

Maybe Mitch is not doing anything wrong in his country but he should at least understand why we would not just want to make his country worse for the people of the philippines.. read that article! It is a good and insightful read!

The more "foreigners" that go there the less they will bother to try to make it easier for their own people to get a transplant! Is that what we want??

[stauffenberg]

Zach, as you know, science is based on averages, not on anecdotes.  With respect to the average half-life of a kidney from a living donor, for the scientific as opposed to the anecdotal information you have to consult a scientific work, such as Professor D. E. Hricik's "Renal Transplantion" (2003) p. 5, where he writes:  "... between 1988 and 1995, the projected half-life of a living-donor transplanted kidney increased from 12.7 years to 21.6 years during this time period, while the half-life of a cadaver-donor kidney insreaded from 7.9 to 13.8 years ... ."  That is where I got my information for writing that a living-donor kidney could be expected to last around 20 years on average.

I don't feel exploited by Big Pharma for the immunosuppressives I buy, since my insurance covers all but a trivial amount of the cost.  What did make me feel exploited, however, was to be serving Baxter, Kaiser, Fresenius, and an army of otherwise surplus nephrologists with a perpetual income by being kept trapped in a dialysis center that no one, from the government officials who made the transplant policy so restrictive there was nearly no hope of a cadaver transplant, to the researchers, mainly employed by the same companies making a profit off of me, who tinkered and dithered in their labs for decades without ever finding a way to free their 'cash-cow' from its pen -- I wonder why?!  Even if I were burdened with having to pay the cost of the overpriced immunosuppressives myself, I would still not mind as much as being on dialysis, which robbed me of my freedom rather than of my money.

After you compare all the numerous advantages and disadvantages of dialysis and transplant as treatments for endstage renal failure, neither is perfect, but on balance, transplant is infinitely better.  To bring a complex comparison down to a single, bottom-line number, the projected years of life for all patients of all ages on dialysis who are young and healthy enough to be selected for the transplant list is 10 years, while that for all patients of all ages with even just a cadaver transplant is 20 years.  (R. Wolfe, et al, "Comparison of Mortality in All Patients on Dialysis Awaiting Transplantation and Recipients of a First Cadaver Transplant," New England Journal of Medicine, vol 341, no. 23 (1999) 1725-1730.

Both Angie and Zach were concerned about transplant tourism somehow ruining the whole healthcare system in a nation of seventy million people or that transplants for foreigners would somehow keep Filipinos from getting a transplant.  As to the first point, 'transplant tourism' is a huge industry, comprising everything from plastic surgery to liposuction, and in that mass of foreign patients the number of people seeking a kidney transplant is miniscule.  As to the second point, there are many, many more people in the Philippines lining up to become kidney donors for pay than there would ever be a demand for their services, so the few foreigners who come to the Philippines for that purpose will simply be adding as many live-donor kidneys to the supply as they put pressure on the supply, so their impact will be absolutely zero on the availability of kidney donors for the local patients.  In any case, the locals themselves who get a kidney transplant fall into two classes: those who are Philippine ex-patriots who make or made their money abroad and return to their homeland for a transplant, so their money is foreign money, just as much as that of the transplant tourist.  The other class are those patients with relatives abroad who make good money at jobs in Western countries and send it home so a relative can get a transplant, and in this case as well the money is foreign.  It would be very rare for a purely domestic patient ever to afford to be able to pay for the operation, never mind for the donor, and that is the fault of the Philippine government for not having a free national healthcare service, and instead sending the country's money in buckets to Swiss bank accounts.  But that is not the fault of the comparatively small number of foreigners coming to the Philippines seeking a transplant, whose number I would guess at around a hundred people a year at most.

[mitchorganbroker]

Angie and Mallory, that article which tells of future doom to the Government and public Hospitals in the Philippines
is political propaganda for the anti Government Philippine people to follow the crowd but is only the author's opinion. These comments are not logical since these government medical services to the poor have always been ground floor shit( like care for the Vets), so how can it be doomed.? (No they don't have basements) Furthermore the Government spokesperson( Mr. Del Mundo) for the Dept of Health, already commented (in the daily Inquirer) the foreign transplant patient need to bring their own donor, which would eliminate transplants for foreigners.
    The silly article likes to forget, that transplants were not to be done with medical tourism. Now Mallory and Angie like to forget it also. ( Ladies, read again, the article which quoted that Dept. of Health guy Mr.Del Mundo.)
     Doctors do not work only for altruistic reasons, they like the challenge, the good feeling that solving or helping a difficult medical case gives the Health care provider. Doctors as well as successful Philippine  Surgeons do give charity. But starting out Doctors can't do what the established doctors give. They have families to support and medical school loans to pay back. Now their parents who struggled for them are now elderly with medical conditions of their own. If helping ESRD patients get transplanted makes me a pimp, what name should we call  people who scare ESRD patients into  trapping themselves in that dialysis prison ?
   To recap : that article talks of future doom. How in blazes can you consider it like a fact ?

[mallory]

Mitch, I work in Marketing.  It's my job to make our product attractive and salable to customers.  To do that, we offer excellent customer service and problem solving for our clients on an ongoing basis over the term of their relationship with our company.  The majority of our customers are with us for many, many years. 

Your marketing technique is interesting to me.  Fear, intimidation, belittling and/or demeaning your potential customers; how's that working out for you?  I would never consider getting a transplant through your organization, largely because of the methods you've employed to attract business.  Your whole approach seems unsavory to me.  I don't see you as someone that I could trust with my very life.

Apparently there are others that agree with me.  Here's an article that mentions you specifically:

http://www.medicalnewstoday.com/medicalnews.php?newsid=3737

And here's another that calls your organization the Toys R Us of the liver trade:

http://www.findarticles.com/p/articles/mi_m0ISW/is_267/ai_n15795060/pg_1

Here's another article with more information on the negative impacts selling a kidney has on the donor:

http://findarticles.com/p/articles/mi_m0JQP/is_2003_March/ai_99232383

A quote from the article:

"WHILE kidney selling is a deeply stigmatized act in Moldova, it has become a routine event in slums and shantytowns half a world away in the Filipino capital of Manila. This is despite the fact that the operation has put a great many young men permanently out of work, Kidney sellers say they are no longer able to lift heavy cargoes. 'No-one wants a kidney seller on his work team,' an unemployed father of three told us while his wife fumed at him from a distance."

And the same article outlines risks to the recipients as well:

"Bangon Lupa is a garbage-strewn slum built on stilt shacks over a polluted and faeces-infested stretch of the Pasig River that runs through the shantytown on its way to Manila Bay. In Bangon Lupa 'coming of age' now means that one is legally old enough to sell a kidney. But as with other coming-of-age rituals, many young men lie about their age and boast of having sold a kidney when they were as young as 16 years old. 'No-one at the hospital asks us for any documents,' they assured me. The kidney donors lied about other things as well --- their names, addresses and medical histories, including their daily exposure to TB, AIDS, dengue and hepatitis, not to mention chronic skin infections and malnutrition."

So, Mitch, you have not sold me on a transplant in the Philippines.  And you seem to be missing an important point:

If helping ESRD patients get transplanted makes me a pimp, what name should we call people who scare ESRD patients into trapping themselves in that dialysis prison ?

Angie and I are not suggesting or recommending that ESRD patients not get transplants, we're recommending that if they decide to get a transplant, they should not get it through you.

[angieskidney]

If helping ESRD patients get transplanted makes me a pimp, what name should we call people who scare ESRD patients into trapping themselves in that dialysis prison ?

Angie and I are not suggesting or recommending that ESRD patients not get transplants, we're recommending that if they decide to get a transplant, they should not get it through you.

Ya pretty much! I mean, come on Mitch! You ALREADY KNOW that I am not against transplants as you KNOW I have had one before and AM BACK ON the transplant list for another!

You keep twisting ALL of our words saying we "Trap" ourselves!

You got it all wrong Mitch and if you want our respect much less actually believing you have any integrety, then give us the pros and cons so we can feel confident in any decision we make regarding any foreign kidney transplants!

The kidney would go into OUR bodies so we have EVERY RIGHT to be scared of what comes from your country in less than moralistic means!

You make me nervous as much as a used car sales man saying if I don't buy your used car then I am "Trapping" myself by sticking to riding my bicycle in the snow as winter comes. Buying your used car (or used kidney) could lead to more problems I am not willing to take on!

Your marketing technique is interesting to me. Fear, intimidation, belittling and/or demeaning your potential customers; how's that working out for you? I would never consider getting a transplant through your organization, largely because of the methods you've employed to attract business. Your whole approach seems unsavory to me. I don't see you as someone that I could trust with my very life.

EXACTLY!! That is why I am apprehensive myself!!

[stauffenberg]

Mallory, when you quote to me anecdotes from a newspaper article suggesting that there are enormous health problems in donating a spare kidney in reply to my citation of articles by professors of medicine, published in prestigious, peer-reviewed, professional medical journals, backed by controlled studies and rigorous statistical analysis, then I think even you would agree that the journalist's sensationalism cannot compare with the medical opinion that donating a kidney is essentially harmless.  Do you think that the newspaper editor for whom the reporter writes the story believes he can increase circulation by blandly stating that kidney donation is harmless, as the medical journals say, or do you think he needs a real shocking, heart-wrenching story to catch the reader's attention?  In the medical journal "Transplantation" (vol. 64, no. 7, 1997, pp. 976-978) Ingela Fehrman-Ekholm, who has not a journalism degree but an M.D., published an article provocatively titled "Kidney Donors Live Longer," in which she found in studying a cohort of kidney donors over 31 years in comparison with a random cohort of age-matched people who had not donated a kidney that "survival was 29% better in the donor group" than in the non-donor group!

Also, the Philippines is not India.  The transplant hospitals there conduct extensive medical checks of the donors over two weeks before accepting a kidney from them, which include Doppler ultrasound, electrocardiogram, renal function tests, tissue typing, and infectious disease screening.  I even spoke with the resident infectious disease expert at one of the hospitals.  Forty years of American occupation have westernized the medical practice in the Philippines much more than it is in the rural Indian hospitals where transplants are still performed now that it has been declared illegal in India to pay donors for a kidney transplant.  On the examination of the competence of foreign medical graduates to enter practice in the United States, the ECFMG exam, graduates of the University of Manila have the highest pass rate in the world.

[sandman]

"WHILE kidney selling is a deeply stigmatized act in Moldova, it has become a routine event in slums and shantytowns half a world away in the Filipino capital of Manila. This is despite the fact that the operation has put a great many young men permanently out of work, Kidney sellers say they are no longer able to lift heavy cargoes. 'No-one wants a kidney seller on his work team,' an unemployed father of three told us while his wife fumed at him from a distance."

Whow!  Wait a second.  I was not aware of that.  Is that true?  If I was to donate a kidney, would that hamper my ability to pick up and carry heavy objects?

Mallory, when you quote to me anecdotes from a newspaper article suggesting that there are enormous health problems in donating a spare kidney in reply to my citation of articles by professors of medicine, published in prestigious, peer-reviewed, professional medical journals, backed by controlled studies and rigorous statistical analysis, then I think even you would agree that the journalist's sensationalism cannot compare with the medical opinion that donating a kidney is essentially harmless.

Now since when did a second kidney become classified as a "spare"?  Generally, you are born with two kidneys and your body uses both of them at the same time.  One of them does not work as a back-up unit for when the first one gets taken off-line, so to speak.  I can agree that is has been clinically proven that you can function with one kidney but at no time while you have two functional kidneys, does one remain dormant until it is needed.  Please show me proof that a second kidney does in fact work as a back-up unit.

A fifth tire for your car is a "spare" tire.  A second kidney is NOT a spare.

[mitchorganbroker]

Mallory, Angie, Yes you are for transplants, as long as it is FREE. The expectation of a naive altruistic free donor coming along to risk his life for a  selfish person is outrageous. It's about money with you guys. Angie, all the free medical services and free housing in Canada , did you contribute 1 % or less when you were working?
    Mallory, when you do your marketing are you facing people ignorant of the facts  who insult you, calling you a pimp and wanting your product for free and asking for the component address, so they can go around you  ?
Those donor surveys where they had to pay donors for their comments are misleading and useless .
   The Pro and con:
       Pro -Live matched donor in two weeks , . In one month you are are free from dialysis.and NORMAL
       Then you live a normal life as before.

   The con
      It's not free , you have to pay for it.
      Your medicare is useless in an other country. You have to put up with insults from the ignorant .
      You will tremble from all the propaganda , repeated mostly by ignorant peers.

Questions for you thinkers : If you travel to an other state for a transplant , is that medical Tourism ?
       Is it only medical tourism if you travel to an other country.?
   Is the highly paid man working at a US hospital, who helps you get a kidney transplant called a broker ?
   Is he a transplant coordinator or a dirty broker.    

Who is the person to blame for preventing you from getting a kidney transplant ? Is it the slow moving altruistic guy or the druggy who hasn't crashed into a tree yet.? The answer is in your mirror.
------------------------------------------------------------------------
Sandman , Mallory uses BS articles from unsavory rags. That stuff is not medical journals. Actually it's from reporters who are paid to propagandize about foreign transplants. That's how they make a living.
  Both normal kidneys work at the same time but do not need to work very hard to get the job done.

[Zach]

Zach, as you know, science is based on averages, not on anecdotes.  With respect to the average half-life of a kidney from a living donor, for the scientific as opposed to the anecdotal information you have to consult a scientific work, such as Professor D. E. Hricik's "Renal Transplantion" (2003) p. 5, where he writes:  "... between 1988 and 1995, the projected half-life of a living-donor transplanted kidney increased from 12.7 years to 21.6 years during this time period, while the half-life of a cadaver-donor kidney insreaded from 7.9 to 13.8 years ... ."  That is where I got my information for writing that a living-donor kidney could be expected to last around 20 years on average.

stauffenberg, your Abbott & Costello routine with mitchorganbroker is fraying at the edges.
Come over to the other side!

[kitkatz]

Bathe in the Light. Come over from the dark side.

[Zach]

Here are the facts:

Kidney Transplants
                                                   5 Years
Living Donor Graft Survival                  80.2%

                                                  10 Years
Living Donor Graft Survival                  56.4%

As we can all read, there is a significant drop after 5 years.  These are actual patients.

Half-life is calculated by estimation of projected median years. Half-life means that half of the kidneys will function fewer than the stated years and half will survive longer.

How many transplants has Mitch arranged?  How many years has he been providing this service?

There is no question that a functioning kidney is better than not having one.  That's not the issue.
I'm looking at it simply as a business deal--risks vs. benefits.



Source: United Network of Organ Sharing (UNOS) Scientific Renal Transplant Registry
OPTN/SRTR Data as of May 2, 2005.

10 Years = 1993-2003 --Yes, a lot has changed in the anti-rejection medications since 1993.  But there is still the problem of chronic rejection.

http://www.optn.org/AR2005/default.htm

[angieskidney]

Mallory, Angie, Yes you are for transplants, as long as it is FREE. The expectation of a naive altruistic free donor coming along to risk his life for a  selfish person is outrageous. It's about money with you guys. Angie, all the free medical services and free housing in Canada , did you contribute 1 % or less when you were working?

I think I have contributed every time I have worked (over 9 years 12hr wing shifts + overtime without overtime pay).

  The Pro and con:
       Pro -Live matched donor in two weeks , . In one month you are are free from dialysis.and NORMAL
       Then you live a normal life as before.

   The con
      It's not free , you have to pay for it.
      Your medicare is useless in an other country. You have to put up with insults from the ignorant .
      You will tremble from all the propaganda , repeated mostly by ignorant peers.

Questions for you thinkers : If you travel to an other state for a transplant , is that medical Tourism ?
       Is it only medical tourism if you travel to an other country.?
   Is the highly paid man working at a US hospital, who helps you get a kidney transplant called a broker ?
   Is he a transplant coordinator or a dirty broker.    

Who is the person to blame for preventing you from getting a kidney transplant ? Is it the slow moving altruistic guy or the druggy who hasn't crashed into a tree yet.? The answer is in your mirror.

I wouldn't want a kidney from a druggy.

A transplant coordinator is NOT a broker simply because they don't push you to have the surgery if you are apprehensive about it. They especially do not keep pushing and pushing for you to have it in a country where you are not even covered!!

Sandman , Mallory uses BS articles from unsavory rags. That stuff is not medical journals. Actually it's from reporters who are paid to propagandize about foreign transplants. That's how they make a living.
  Both normal kidneys work at the same time but do not need to work very hard to get the job done.

So when you donate a kidney then your other kidney has to work extra hard. Sure it can pick up the slack. Hopefully there are no other problems. If there are then oh boy!

How many transplants has Mitch arranged?  How many years has he been providing this service?

This is no question that a functioning kidney is better than not having one.  That's not the issue.
I'm looking at it simply as a business deal--risks vs. benefits.



Source: United Network of Organ Sharing (UNOS) Scientific Renal Transplant Registry
OPTN/SRTR Data as of May 2, 2005.

10 Years = 1993-2003 --Yes, a lot has changed in the anti-rejection medications since 1993.  But there is still the problem of chronic rejection.

http://www.optn.org/AR2005/default.htm

I want to know as well!

[mitchorganbroker]

Zach, was the donor graft referring to only kidneys or all organs ?
I have been in this line of work since Nov of 2001, prior to that I was treating medical patients in the US as an MD.
If I count the Liver transplants, which was the original focus of Liver4you it's almost a hundred. I realize that people worry about the risk to their money. When Lawyers are involved in any financial transaction, everyone feels safer. A two lawyer approach is a viable option to protect your money and our intellectual rights.
   The other options with the pros and cons:
     China - transplants cost 50 % higher than the Philippines and the use executed prisoners which is legal in their country.  As to how old the kidney was, I am not sure but I would wager that the primary patient for that donor was the highest price operation, like heart or lungs , while the rest of the organs sat on ice.
    Pakistan- It's the cheapest place but it's illegal while it's not in-forced. Is the Philippines transplant better that the one done in Pakistan ? I got to ask that to a Pakistan ESRD patient who had contacted me. I will paste our E-mail correspondence below :
 
"Being on dialysis for 5 years, i have heard and seen patients returning to dialysis after transplants done in Pakistan because of various reasons. Most patients that get it done from Philippines are doing well.Thank you for your help.
Amy

----- Original Message -----
From: fast transplant
To: _________
Sent: Wednesday, August 09, 2006 1:43 PM
Subject: Re: Kidney Transplant - Assistance

Amy,
I will see if I can get the information you requested.
Is there a reason that you do not get the transplant in Pakistan ?
Mitch Michaelson


Dear Sir / Madam,

I live in the United Arab Emirates although i hold a Pakistani passport. I would very much like your assistance in getting the information of a doctor in Philippines.

Born with Spina Bifida and then CRF, i am now on dialysis for the past 5 years and would very much like to get a transplant.

The Doctors name is _______and he works for Transplant Institute. If you could please assist me in getting his email address or his office telephone number.

Your assistance is very much appreciated!

Warm Regards,

Amar Zahra (Amy) "

 
 
 

[Zach]

Zach, was the donor graft referring to only kidneys or all organs ?

Just kidneys.

[stauffenberg]

Zach, I think part of the reason the published data I cite diverge from yours is that the data I was using refers to the projected half-life of live donor kidneys transplanted now with the current improvements in transplantation drugs and the refinement of the techniques by which they are used.  The UNOS data records the already established results from the past, which would represent the outcomes from a more primitive drug regimen (i.e., still using more prednisone than necessary, still employing azathioprine, and not yet using Sirolimus).

Sandmansa, I agree that when two kidneys are present, both are being used, so one is not a 'spare' in the sense that a spare tire is an 'extra' tire.  However, what is relevant for the question of the ethics of buying a kidney from a living donor is that the second kidney is 'spare' in the sense that the patient's health and renal function can be just as good as normal without it.  It is also 'spare' in the sense that evolution expended all the energy in producing a second kidney mainly to protect humans against accidental destruction of just one kidney through trauma, which is today so rare an event that it does not even appear on the charts of causes of renal failure, but in the days of cavemen chasing mastadons may have been common enough for the second kidney to have been important.

[mallory]

Sandman , Mallory uses BS articles from unsavory rags. That stuff is not medical journals. Actually it's from reporters who are paid to propagandize about foreign transplants. That's how they make a living.
 

Mallory, when you quote to me anecdotes from a newspaper article suggesting that there are enormous health problems in donating a spare kidney in reply to my citation of articles by professors of medicine, published in prestigious, peer-reviewed, professional medical journals, backed by controlled studies and rigorous statistical analysis, then I think even you would agree that the journalist's sensationalism cannot compare with the medical opinion that donating a kidney is essentially harmless.

Mitch and Stauffenberg,  Nancy Scheper-Hughes wrote the article you are both referring to as sensationalism.  She is a Professor of Medical Anthropology at the University of California, Berkeley.  I've never heard anyone refer to the New Internationalist as an "unsavory rag" before, and I hardly think you can question Scheper-Hughes' credentials.  Should you still question her background or credibility, her is a link to her Curriculum Vitae:

http://ls.berkeley.edu/dept/anth/nshcv.pdf

Here is a link to another article (it is very long) by Scheper-Hughes on the global commerce in organs for transplant surgery:

http://sunsite.berkeley.edu/biotech/organswatch/pages/endsofbody.html

And yet another on her work:

http://www.berkeley.edu/news/magazine/summer_99/feature_darkness_scheper.html

Both of the articles above are in UC Berkeley publications, certainly credible sources.  Do either of you, Mitch or Stauffenberg, have comparable articles regarding organ donors in the Philippines?  Anything with statistics showing the end results of the sale of organs on a person's financial and/or social status, employment or lifespan, specifically in the Philippines?  Because Scheper-Hughes' articles do reference the Philippines specifically, and, the information is not positive.

Mallory, Angie, Yes you are for transplants, as long as it is FREE. The expectation of a naive altruistic free donor coming along to risk his life for a  selfish person is outrageous. It's about money with you guys.

Mitch,  Are you reading our posts, or just responding?  Angie and I have repeatedly told you that this has nothing to do with money.  Neither of us is holding out waiting for a free kidney.  We are against the idea of turning poor people into commodities for rich people.  We're against the dehumanizing of the people in the Philippines or anywhere else in the world.  We are against kidney brokers making money from the suffering and fear of donors and recipients.

Mallory, when you do your marketing are you facing people ignorant of the facts  who insult you, calling you a pimp and wanting your product for free and asking for the component address, so they can go around you  ?

Yes, Mitch, people I work with every day do not understand my business, they sometimes insult us, they always want our product for free and, because we have competition, they can always go to other companies in lieu of working with us.  And yet, we still do not find that insulting, demeaning or belittling our customers increases our business.  It doesn't appear to be working for you, either.

[Sluff]

I think this thread has reached a point of pointlessness. Just my  worth