Transplant Surgery abroad is not the same in every country

[meadowlandsnj]

Yale Professor Urges Payment For Organ Donation

October 9, 2006 12:32 p.m. EST


Mary K. Brunskill - All Headline News Staff Writer
New Haven, CT (AHN) - A Yale University School of Medicine professor says a regulated system for paying people to donate organs would diminish the "desperate" need for organs and counter exploitation.

Professor Amy Friedman, who has worked as a transplant surgeon for 15 years, believes paying organ donors through a government-supervised system would help bridge the gap of access to transplants between those who have money and those who do not. Even though there currently are laws prohibiting the sale of organs, some wealthy people are able travel to other countries to buy organs such as kidneys.

Friedman says all laws would have to be monitored, most likely by the government, and supervised by medical and transplant professionals, representatives of patients and donors, and social workers.

Friedman says, "Bringing these activities out of the closet by introducing governmental supervision and funding will provide equity to the poor, who will have equal access to such a transplant."

However, other experts believe such a system would inevitably create more exploitation and would end up hurting the very people Friedman aims to help - low-income people who are desperate for money.

Professor Stephen Wigmore, chairman of the British Transplantation Society Ethics Committee, tells BBC News, "The problem still remains that nobody is going to sell a kidney unless they need the money. Even if you give a kidney to a poor person, it's still going to be a vulnerable person who donated it."

He said, " ... people don't really know what happens to living kidney donors in the long term - do they have normal mortality or do they develop kidney failure at 60 and need a transplant themselves?"

[meadowlandsnj]

From Nature Clinical Practice Nephrology

The Case Against a Regulated System of Living Kidney Sales
Posted 09/29/2006

Vivekanand Jha; Kirpal S Chugh 

The number of individuals on a waiting list to receive a kidney currently exceeds 100,000 globally. In the developing world, access to health care and financial issues are the major barriers to renal replacement therapy, but in the advanced industrialized nations, shortage of transplantable organs is the chief reason for continued growth of the waiting list. This gap between supply and demand could be reduced by allowing willing individuals to sell their organs. Donation of organs for money, however, was made illegal in most countries following the emergence of large-scale organ marketing operations supported by unscrupulous brokers and middlemen, especially in the developing countries of South Asia.

The arguments supporting organ sale need to be examined carefully. The differences between the sale of irreplaceable organs and that of essentially renewable tissues such as blood or sperm must be appreciated. Removal of a kidney involves major surgery under anesthetic, which is far more invasive than obtaining any of the aforementioned tissues. Furthermore, it is imperative that we recognize the immorality of allowing people to do serious damage to themselves for the sole purpose of making money. In some instances, individuals who have already sold a kidney have expressed their willingness to donate a second one and take the risk of living on dialysis.[1]

Unacceptably high recipient mortality and transmission of infections, including HIV and hepatitis, have been consistently reported following transplantation of purchased kidneys.[2-4] There is, however, a remarkable paucity of outcome data from such transplantations. Some reports from Iran have claimed success rates equivalent to living related donor transplantations;[5] however, these have been published only in review papers, and the data not rigorously peer-reviewed.

There are few data to show that the financial compensation received by organ donors in developing countries has helped improve their lives. It is common knowledge that donors are underpaid, and that their postoperative medical care is absent or suboptimal. Reports in the lay press have documented high rates of donor mortality and morbidity. Interviews with over 300 kidney sellers near Chennai, India[6] revealed that about 75% of participants whose motive for selling the kidney was payment of debts continued to be in debt and almost 90% reported significant deterioration in their health after donation. Zargooshi[7] documented widespread practice of extralegal financial transactions, coercion and blackmail between donors and recipients in Iran, where financial reward through an independent agency is legal. Although others dispute Zargooshi's observations, independent observations have supported his findings.[8]

So far, financial compensation for kidney donors in most places has been arbitrary, subject to bargaining between the donor and the middleman and dependent on the donor's level of awareness about the value of a kidney. Accurate figures are not available, but in South Asian countries it is estimated that of US$2,000-2,500 paid by the recipient for a kidney, only about $1,000-1,200 reaches the donor. US estimates of appropriate purchase price of a kidney vary from $45,000 to $90,000.[9,10] Once money enters the equation, the argument of allotting the purchased kidney only on medical grounds in an open market economy stands on thin ice. Why should a desperate recipient willing to pay the price not be allowed to go to the top of the waiting list, or the degree of 'matching' between the donor and the recipient not decide the price? Why should the price not be decided at auction so that the seller gets the highest value for an asset that he or she can sell but once?

Enforcement of current transplantation legislation is uneven in many countries. The presence of illegal middlemen or brokers is not doubted.[8] There have been allegations of active collusion of transplant surgeons, nephrologists and members of the regulatory bodies in facilitating commercial transplantations, often with the help of forged documents, and the failure of the law in preventing this activity is well-documented.[11,12] A charitable view could be that these transplantations are performed out of a sense of pity for the recipients; however, there is a strong suspicion that financial gain is the main motivation. It is hard to imagine that in societies where there is a combination of desperate individuals, greedy and unscrupulous facilitators and poorly developed justice systems, transplantation would remain untouched by all-pervasive corruption.

Schemes for setting up government-funded and regulated paid kidney donation programs that give equal opportunity to rich and poor people, and guarantee health care to the donors, have been proposed. Getting such programs to work, however, would be a major challenge. Even the proponents of regulated sales concede that such models can apply only to Western countries that have well-established systems of implementation and monitoring to ensure fair and equitable distribution through existing domestic networks. Inherent in such schemes is the assumption that strict geographical containment is possible.

Once the initial rush of domestic donors is exhausted, the globalization of organ trade, whereby donors would come in large numbers from the developing world to supply organs to the industrialized world, is inevitable. The acceptance of even a limited domestic organ market in the advanced nations will act as the proverbial thin end of the wedge and encourage adoption of commercial donation in the developing world. This view was endorsed by the National Kidney Foundation in a testimony to the US Congress where Dr Francis Delmonico argued that "...a US congressional endorsement for payment would propel other countries to sanction unethical and unjust standards...".

Paid transplantations negatively affect living related and cadaveric transplantation in developing countries.[13] When cheap organs are available, people often opt to buy one rather than subject a loved one to the risk of donation. There are other strategies apart from organ sales that can increase donation rates, such as public awareness campaigns, a 'presumed consent' law, use of marginal donors and performing ABO-incompatible or paired-exchange transplantations. An element of reciprocity could also be injected into the system, so that—for example—people can choose to donate organs only to those who have in turn indicated their willingness for the same.

The arguments supporting a regulated organ market are extremely simplistic, and ignore the ground realities. Allowing such an activity in any corner of the world would open the doors for rampant exploitation of the underprivileged in areas that are already plagued by vast economic inequalities. It is important that the transplant community approaches this issue with a sense of responsibility towards society that is equal to the compassion it shows towards its patients.


CLICK HERE for subscription information about this journal.

References
Broumand B (1997) Living donors: the Iran experience. Nephrol Dial Transplant 12: 1830-1831
Higgins R et al. (2003) Kidney transplantation in patients travelling from the UK to India or Pakistan. Nephrol Dial Transplant 18: 851-852
Ivanovski N et al. (1997) Renal transplantation from paid, unrelated donors in India—it is not only unethical, it is also medically unsafe. Nephrol Dial Transplant 12: 2028-2029
Inston NG et al. (2005) Living paid organ transplantation results in unacceptably high recipient morbidity and mortality. Transplant Proc 37: 560-562
Ghods AJ (2002) Renal transplantation in Iran. Nephrol Dial Transplant 17: 222-228
Goyal M et al. (2002) Economic and health consequences of selling a kidney in India. JAMA 288: 1589-1593
Zargooshi J (2001) Iranian kidney donors: motivations and relations with recipients. J Urol 165: 386-392
Scheper-Hughes N (2003) Keeping an eye on the global traffic in human organs. Lancet 361: 1645-1648
Becker GS and Elias JJ (2003) Introducing incentives in the market for live and cadaveric organ donations. Conference on Organ Transplantation: Economic, Ethical and Policy Issues: 16 May 2003; University of Chicago, IL, USA.
Matas AJ and Schnitzler M (2004) Payment for living donor (vendor) kidneys: a cost-effectiveness analysis. Am J Transplant 4: 216-221
Mudur G (2004) Kidney trade arrest exposes loopholes in India's transplant laws. BMJ 328: 246
Passarinho LE et al. (2003) Bioethical study of kidney transplantation in Brazil involving unrelated living donors: the inefficiency of law to prevent organ commercialism. Rev Assoc Med Bras 49: 382-388
Mani MK (2002) Development of cadaver renal transplantation in India. Nephrology 7: 177-182
 

Reprint Address

National Kidney Clinic and Research Centre, 601, Sector 18, Chandigarh 160 018, India. chughks_chd@dataone.in
 
 

 
Vivekanand Jha is Additional Professor of Nephrology at the Postgraduate Institute of Medical Education & Research, Chandigarh, India.

Kirpal S Chugh is Emeritus Professor of Nephrology at the Postgraduate Institute of Medical Education & Research, Chandigarh, India.
 

[Sluff]

Remember if we don't respond further on this thread, then Mitch will have to carry on with himself. Those that are in disagreement should just refrain from posting because it just brings this thread to the top everytime to the amusement of Mitch.
                                    I for one am done with this thread.  

[Sara]

Unfortunately he is now posting in other areas of the board.   

[BigSky]

Hate to say it but whether he makes money or not plays no role in the matter and has nothing to do with it.

Just for the reason every transplant center and doctor doing them in the US makes money also from transplants.  In fact they make sure they are going to get payment before you are even worked up.  This was the very first thing they asked me before anything was else was mentioned.

The only part that plays into this is the ethics on the what if's that could happen if organ selling was widespread.

[Epoman]

Unfortunately he is now posting in other areas of the board.   

He has just posted in 2 other threads, the member pics thread and the motorcycle thread in off-topic, he asked my permission to post in the motorcycle thread and I let him since he told me he was a motorcycle rider and since he had been playing by the rules that I set with him when I allowed him this one thread. I did NOT however give him permission to post in the "Members Pictures" thread. I have emailed him and gave him a warning not to post outside of this thread any further or he will be banned. I apologize to the members if him posting his pictures or posting outside of this thread upsetted you and it will not happen again. I gave him this one thread to allow people to make their own decision on his practices and to judge him and his service for themselves. 

Mitch, as you read this understand this is your last warning to stay within this thread, you are not allowed to post in any other thread, you doing so has upsetted several members. Please understand that I was very generous to allow you to have your "say" and let the members hear your side of the story even after you spammed this site and even resorted to calling "me" names. Please respect me and my members or I promise you will never be allowed on this site again. I will do everything in my power to stop you even if that includes going back to having to "Approve" members before their account is active and they can make their first post.

- Epoman
Owner/Admin

[Sara]

Thank you, Epoman.

[mitchorganbroker]

To those who were upset that I posted photos, I apologize. After I learned how to resize photos I jumped at what I thought was an open invitation to all members to post pictures. I didn't realize at that moment that I wasn't invited
. As for my fondness to motorcycles , I shared that with the motorcycle group. I learned from Sandman and Sluff with our different tastes in 2 wheel riding.   I almost became a cadaver donor on three occasions.
Sluff, i guess I can't show my other 3 ( Norton 500, BSA 650, FN 175) past motorcycles.
             I read it somewhere that laughing and feeling happiness helps our immune system fight diseases.
    Hey guys, Sorry for the difference of opinions, but I do believe that pursuing hobbies or motorcycle riding can help people with ESRD stay healthier and certainly happier.
    Epoman, that's one fine looking Epokid , you got.
   

[Sluff]

Thanks Epoman.

[livecam]

Man he is one ugly p*ck even with the hairpiece.

[Sluff]

Goofynina 1000 posts is that like the mile high club?  lol

[vandie]

Man he is one ugly p*ck even with the hairpiece.

Very emotional subject, but was this necessary?

[mitchorganbroker]

Philippine dialysis units were both inside the Transplant Hospitals and stand alone centers. They had a high ratio of staff to patients. Some Units had 7 Nephrologists rotating daily and alot of RNs who did the sticking. When I compared my American patients to the Philippine patients the differences became apparent. The American patients had a much higher flow rate with either a good fistula or a central access.. The local patients used a simple needle to a vein, although some used that plastic sheith which slides over the needle .
    Since most were only coming once a week they were not doing to well but staying alive. Many had a slght greenish tint to their complextion. The American patient by comparison looked normal all around and had a much deeper knowledge than the Filipino patients.
   The situation for ESRD patients in Thailand is worse as far as access to dialysis, since the units are mostly "in-patient" and expensive. They do related donor transplants but only with Thai citizens.
    Both of these countries have some fancy private hospital rooms. I have been a patient a few times and was fine with my experience.

[goofynina]

Man he is one ugly p*ck even with the hairpiece.

Livecam, that was not called for, must i remind you that name calling is against the rules and it is a banable offense.  I would've never thought i would hear someone such as yourself say something like that 

Goofynina/Moderator

[mitchorganbroker]

Should unrelated donors in the Philippines ( or elsewhere) be given Health insurance ? Should their long term well being be assured and documented ? Is this done for donors in the US/UK, or in any place ?  

       We will be giving our donors major Medical insurance, Disability Insurance, Life Insurance .
We will have a donor informed consent form listing known risks, signed by both the donor and the Doctor.
We shall make public a donor testing check list including all the tests preformed in the American/ Canadian/ UK Transplant Hospitals .
Our new Health Insurance provider shall keep a copy of the Medical follow up records of the donor.
This can be made public with the donor's signed consent. 

[angieskidney]

Should unrelated donors in the Philippines ( or elsewhere) be given Health insurance ? Should their long term well being be assured and documented ? Is this done for donors in the US/UK, or in any place ?  

       We will be giving our donors major Medical insurance, Disability Insurance, Life Insurance .
We will have a donor informed consent form listing known risks, signed by both the donor and the Doctor.
We shall make public a donor testing check list including all the tests preformed in the American/ Canadian/ UK Transplant Hospitals .
Our new Health Insurance provider shall keep a copy of the Medical follow up records of the donor.
This can be made public with the donor's signed consent. 

It is good to know you are doing SOMETHING that doesn't benefit just yourself

How are you able to provide this service for your people?

[Sara]

Should unrelated donors in the Philippines ( or elsewhere) be given Health insurance ? Should their long term well being be assured and documented ? Is this done for donors in the US/UK, or in any place ?  

       We will be giving our donors major Medical insurance, Disability Insurance, Life Insurance .
We will have a donor informed consent form listing known risks, signed by both the donor and the Doctor.
We shall make public a donor testing check list including all the tests preformed in the American/ Canadian/ UK Transplant Hospitals .
Our new Health Insurance provider shall keep a copy of the Medical follow up records of the donor.
This can be made public with the donor's signed consent. 

It is good to know you are doing SOMETHING that doesn't benefit just yourself

How are you able to provide this service for your people?

Why is this being done all of a sudden?

[BigSky]

   We will be giving our donors major Medical insurance, Disability Insurance, Life Insurance .
We will have a donor informed consent form listing known risks, signed by both the donor and the Doctor.
We shall make public a donor testing check list including all the tests preformed in the American/ Canadian/ UK Transplant Hospitals .
Our new Health Insurance provider shall keep a copy of the Medical follow up records of the donor.
This can be made public with the donor's signed consent. 

That is something the US lacks and should be doing itself to those that are living donors.

[mitchorganbroker]

I remember when I was living in Belgium I had national health insurance which they called Mutuality. It was somewhat similar to what the British have (NHS). This was the best Health Insurance I ever had. In the US I had Blue Shield /Blue Cross and some additional type of Hospital coverage. When I was on staff at a Hospital, most of the other Doctors would give me professional courtesy.
    I still have insurance coverage here from American Insurance but the deductable 20 % is always higher than I pay here, so I don't even bother submitting forms.
    Recently, with all the discussions here and on Angie's board it dawned on me that the subject that came up the most frequent was the "donor well being". Questions concerning his health into the future was mentioned in one way or an other , alot more often then even  the ESRD patient's concerns for himself/herself.
    I was also hearing alot about the Canadian Universal health system. This meant that all altruistic Canadian donors are under that health Umbrella forever. What about the Philippine donors, I asked myself.? Was it best to depend on the Surgeon alone to keep his promise even after I saw some of the promises broken, regarding money.?
    So , it was time to put my money where my mouth is. I also believe that in the long run , money used to protect the donors, will create more good will and trust even if its very indirect and not tangible. I also feel proud for the first time comparing what I have helped create compared to the American system.
   The catalyst to getting my mind to think about this was reading the Angie Transplant story from 1991. I figure that this way the donor is covered even if he moves far from the Surgeon and it will be my job to make sure he is taken care of.  If anything goes wrong , then I am to blame, personally.

[Sara]

Right, and this has nothing to do with you being chastised and decreasing attention to your thread, huh?

[mitchorganbroker]

Getting people Health Insurance is a win win situation.   
Too bad this is not done in America for those altruisttic donors. 
  I don't recall being chastised . Are you sure you mean me ?  and not that other guy ? I get enough attention and the right kind. Most of my critics were overly concerned with the Philippine donor's well being and not very concerned about the transplant cost.  This showed me that it would makes sense to listen and learn from others.
       Sara, remember your questions about adoption that nobody on the forum could tell you how to do it ?  Guess who will show you the way.  Sara , first stop asking stupid agencies in the US.  You can do it yourself in the Philippines without a broker, without middlemen. There are so many Philippines kids put up for adoption. The younger kids don't understand English so this is where your husbands Tagalog will make the day. The Philippine people would want you guys come and adopt a kid. I bet your Philippine relatives know of many young single moms who need to put the baby into a good home like you two can provide.
      In the Philippines you also ask the Barangay Captain, they know the people well.

[meadowlandsnj]

       Sara, remember your questions about adoption that nobody on the forum could tell you how to do it ?  Guess who will show you the way. 

When I read this I physically shuddered......now you're in the child selling business??  You got your filthy fingers in all the cookie jars, haven't you?  Epoman--you just can't let this joker advertise his "services" here can you?  This is getting really offensive now.

Donna

[Sara]

This is beyond ridiculous now.  Mitch this just shows you know absolutely nothing.  I have researched a great deal and know what the process is and what is required and I highly doubt the ICAB would deal with people like you, especially when it comes down to children.  In fact they might be interested to know the types of things you propose.

This guy needs to go.

[BigSky]

       Sara, remember your questions about adoption that nobody on the forum could tell you how to do it ?  Guess who will show you the way. 

When I read this I physically shuddered......now you're in the child selling business??  You got your filthy fingers in all the cookie jars, haven't you?  Epoman--you just can't let this joker advertise his "services" here can you?  This is getting really offensive now.

Donna

 Seems he told her just what she needs to do.  As shown by:

You can do it yourself in the Philippines without a broker, without middlemen.

Seems to be alot of asinine accusations being thrown around in this thread. 

Facts and only the facts.   .  There is no need for people to try and emotionally charge the issues.

[stauffenberg]

I agree entirely with BigSky.  Mitch specifically pointed out that private adoptions could be easily arranged in the Philippines WITHOUT A BROKER, and then everyone started crticizing him for selling children, which was exactly what he was NOT doing.  This shows how much irrational prejudice there is arising from the unthinking, automatic, knee-jerk revulsion people have against the idea of buying an organ from someone, even though, when you calm down and consider the whole matter logically, what seems revolting is the way renal patients are left to languish and die on dialysis, when their plight could be answered by a method that simultaneously lifts people in the Third World out of poverty.