Black market organs

[MooseMom]

Did any of you happen to catch "Vice" on TV last night?  One of the correspondents did a story called "Kidneyville".

The segment (only 15 minutes long, so short on real information) started with the story of a young girl in El Paso who is on PD.  Her family explains how hard it is on her and the rest of her family, and they also explain how long the wait list is in the US.

The story continues in Bangladesh and explains how very poor people have been left in staggering debt after taking out microloans (which I thought were a GOOD thing!), and their last resort is to sell a kidney.  One village has so many inhabitants who have sold their kidney that it has been nicknamed "Kidneyville".

We've all heard about illegal/illicit organs being harvested and transplanted with the poor selling to the rich.  My question has always been what happens to these recipients AFTER transplant?

Do you all think that many Americans go to developing countries to buy organs and get transplanted?

If so, how do these people return to the US and get the years of aftercare they need?  How do they get their meds?  How do they pay for them, or would their insurance pay? I don't see how they could apply for Medicare. Do they get labs done?  Do they see a nephrologist who is in on this illegal activity?

Does anyone have any idea how this would work for an American who was desperate enough to resort to such a thing?  I'm just curious. 

[UkrainianTracksuit]

As you may know, I'm a researcher/lecturer and my "current" area of expertise is transnational crime.  Organ trafficking is not my forté but it does fall within this category.  I can honestly say the aftercare issue is one that hasn't been investigated thoroughly.  Aftercare would be more an ethical issue rather than the criminal aspect of prevention and breaking up trafficking networks.

I haven't worked on many American case studies but I have researched thoroughly Israeli and Western European cases.

Fact is, there really isn't much oversight for aftercare of both recipient and donor.  Let's face it, authorities or communities don't really care about the donor that was coerced by financial need to donate a kidney.  In the black market, many people are simply killed for their organs so donors are just commodities.  Right now, with the unrest in the Middle East, Syria has become a hotbed for organs just as the Balkan organ trade dominated during those wars.  But, your questions addressed the recipient and simply put, the quality of aftercare a recipient receives depends on the network they are associated with. (Hospitals and doctors that agree to help but look the other way.)  As well, the recipient is just someone that encourages the survival of the trafficking business.  Those that facilitate the transplant don't really care about survival statistics of recipients. 

When a person receives an organ transplant overseas, if it is done legally, there is paperwork and certification from the applicable health services that state the origins of the organ are legal.  In order words, the organs can be traced.  At their arrival home, this certification is presented to their local domestic health authorities and this provides required evidence for the "transplant tourist" to receive adequate funding for medications as well as continued medical supervision.  As we can imagine, those involved in criminal syndicates are smart and extremely business savvy so they are aware of the certification process.  With contacts in the relevant health ministries as well as simply forging documents, the needed paperwork can be supplied.  Lately, laws are changing that if you cannot prove the origins of the newly transplanted organ, then you are on your own for providing funding and care for its lifetime.  Undoubtedly, these people are simply "screwed"!

One common thread seems to emerge.  (An example was noted in an AAKP article called Transplant Tourism: How Dangerous Is it?)  A patient goes away on a "vacation" and misses a bunch of dialysis treatments (if in the market for a kidney.)  They come back home and have mysterious prescriptions for anti-rejection drugs in a foreign language.  Doctors then face ethical challenges: Do I fill the prescription for someone that has bought an organ or let them be sick, end up in hospital where they will receive treatment anyways?  Most recipients will end up in hospital and face rejection due to the lackluster pre-screening conducted by foreign professionals.  Those that are "lucky" enough (I should say wealthy) to enjoy the best possible transplant tourism outcome are those with connections to ensure they have a successful outcome.

Furthermore, there is an unwritten rule where doctors will "drop hints of information" for patients to seek out the black market for an organ.  If the patient does follow this lead, doctors will provide adequate aftercare and remain blissfully ignorant.  Naturally, the majority of medical professionals do not take this route but there are those that do.  Nancy Scheper-Hughes (the pre-eminent scholar on organ trafficking) wrote an academic article in 2002 called "The Ends of the Body" that touched upon this issue.  Personally, I think this is how those who are not extremely wealthy but in search of an organ overseas manage to procure one.  There was a Canadian documentary called "The Market" where an average woman on PD went to India to consider buying an organ.  Her family (daughter and mother) were the ones that found the part of India where most people have sold an organ.  Not much time was spent about legality of the organ as well, the question of who would cover the aftercare costs but there was an "atmosphere" that finding an organ from a broker was one of those things we know are wrong but we let pass.  Check it out to make your own assumption!  Maybe I missed something! 

And then, there are those transplant tourists that have made connections with well-developed networks.  There are international ties with those involved in a hospital in their domestic country and the country where they have received the organ.  When they return home, the medical clinics and doctors provide all the adequate care needed because they are "in the know" and receive a cut of the profits.  Psychology Today wrote in "Body Snatchers: Organ Harvesting For Profit" that "Black market organs are being transplanted in New York, Philadelphia, and Los Angeles at $150,000 a pop...there are "broker-friendly" US hospitals, complete with surgeons who either don't know or don't care where the organs come from."  That raises a whole other issue: the domestic organ trafficking trade.

I don't think I really answered your questions but the one theme that I hope comes through is that aftercare is an iffy subject.  There is no norm on the kind that you receive when engaged in transplant tourism.

This is going to be an even larger problem.  There is a growing disparity between the wealthy and the poor thus a greater opportunity to take advantage of those in deep need.  In 2008, the Declaration of Istanbul was signed to prevent the growth of transplant tourism but the question of aftercare remains up in the air. 

I wish I could help you understand more.  Maybe some of the mentioned articles will provide interesting reading when you have time.  (P.S: I know I don't sound very educated in this posting.  It's late and right now, I think I could fail basic ESL!) 

[PaulBC]

I wish I could help you understand more.  Maybe some of the mentioned articles will provide interesting reading when you have time.  (P.S: I know I don't sound very educated in this posting.  It's late and right now, I think I could fail basic ESL!) 

On the contrary, your reply was well written and informative. It must be quite a dilemma for a doctor to have a patient come back with a transplant of unknown origin.

It's a terrible injustice to exploit someone like this. You know, maybe if you agreed to adopt the donor as an "honorary cousin" the rest of their life and see to their health needs, it could be a fair exchange, but someone willing to give up a kidney for a lump sum small enough to spend in their lifetime is not making a market transaction; they're falling prey to desperation. If the organ is just a commodity, maybe some people can pretend there is no victim. Recipients are also in very desperate straits, so I can see how this happens.

So what could you do if you're a doctor and you have a patient like this? Ethics demand that you help the patient and try to preserve their transplant. At the same time, nobody is going to want to "turn them in." With the US prison system the way it is, I think any move in this direction will lead to likely failure of the transplant, which doesn't really serve anybody's best interest.

It would be useful to carry out an anonymous survey to determine how many doctors are caring for black market transplants. I don't know if there is anything like that, but it would be informative to understand the scope of the problem. It would also have to be done in a way to avoid incriminating the caregivers.

Given the amount of scrutiny kidney patients receive, I believe it is literally impossible for a doctor to imagine that a black market organ came from a legitimate source. Any legitimate organ will have an obvious paper trail. The lack of documentation--even unexplained gaps or irregularities--leaves no other possibility.

[Simon Dog]

lifetime is not making a market transaction; they're falling prey to desperation.

Just because a transaction is made out of desperation, does not mean it is not a "market transaction".  Real up on econ 101

At the same time, nobody is going to want to "turn them in." With the US prison system the way it is, I think any move in this direction will lead to likely failure of the transplant, which doesn't really serve anybody's best interest.

There are relatively few offenses for which the US justice system claim jurisdiction outside of the US.   Espionage; rendering aid to a terrorist organization or procuring minors for sex are all crimes indictable in the US even if committed overseas.

I am not aware of any US law making it a crime to buy an organ in a foreign country.

[MooseMom]

...and then, there are those transplant tourists that have made connections with well-developed networks.  There are international ties with those involved in a hospital in their domestic country and the country where they have received the organ.  When they return home, the medical clinics and doctors provide all the adequate care needed because they are "in the know" and receive a cut of the profits.  Psychology Today wrote in "Body Snatchers: Organ Harvesting For Profit" that "Black market organs are being transplanted in New York, Philadelphia, and Los Angeles at $150,000 a pop...there are "broker-friendly" US hospitals, complete with surgeons who either don't know or don't care where the organs come from."  That raises a whole other issue: the domestic organ trafficking trade.

Thank you for your post; it was lucid and enlightening.

I guess my question is moot because if you are wealthy enough to be able to buy an organ illegally on the US organ black market, then you are probably wealthy enough to pay out of pocket for the years of appointments, monthly lab work and incredibly expensive meds that you will take for the rest of your life.  I guess if your tx center is in on it, they can just (fraudulently) issue prescriptions.

Simon Dog brings up a good question, though.  Is buying a kidney and tx surgery in another country breaking US law, however immoral it may be?  If you are an American patient who goes through with this, what do you tell your insurance company upon your return?  Do people who plan to do this tell their tx center?  I am given to believe that the whole reason an American patient might go abroad for these services is BECAUSE they are cheaper on the front end, so what happens when this patient returns to the US?  Where does he get post-tx care and prescriptions?  All of those labs and doctor appointments are going to cost an awful lot, to the point where not much money is going to be saved on the back end.

I am assuming that most people who are faced with needing a tx or having a loved one facing ESRD have come across these sad stories about black market organs, human trafficking and desperately poor people who are willing to sell bits of themselves.  This is not news to most of us.  But we never hear anything about these recipients once they have their new organ, and I was just really curious about "what happens next". 

I think about the small army of people who support me and my tx needs, and I find it hard to imagine how all of this gets paid for if you have received an organ outside of the system here in the US.  I'm sure it is done, but I don't know how, and I cannot seem to find any information about this.  I'm just curious.  I guess you have to be a "one percenter" to know these things.

[cattlekid]

Hello MooseMom!

I am wondering the same thing about anyone who would go abroad for surgery of any kind.  I am thinking specifically of my husband who recently had gastric bypass surgery.  There were months of tests, almost exactly the same as if you were getting worked up for a transplant.  (and that's what I told him every time he whinged about yet another test or doctor signoff).  Not everyone gets approved for gastric bypass here in the US.  I could easily see someone going abroad to get the surgery because they couldn't get the psych signoff here or didn't meet some other criteria and wanted to take their chances.  There's not nearly as many meds or follow up tests, but they are still significant and all need a doctor's orders. 

Like you said, I guess this is something the 1%'ers have worked out. 

[UkrainianTracksuit]

I am no way an expert on American law but Simon Dog is correct.  It is not illegal for an American citizen to purchase an organ overseas.  However, as with any criminal infraction, if the American citizen was caught in the process of transplant screening, pre-surgery etc in a country with strict transplant tourism laws, they can be arrested and be made into an example.  With the National Organ Transplant Act of 1984 explicitly stating that knowingly buying an organ on American territory is against the law, I can understand those that seek overseas treatment.  However, when you deal with criminal syndicates overseas, you can always assume it is profits over quality.

A trifecta of American renal organizations signed the Istanbul Declaration (2008) but as you know, that has no legal bearing on American law.  The hope is that the works of these organizations, along with their global partners, can combat organ trafficking professionally, lobby and initiate the appropriate legal changes that must be done in their relevant states.

I know that this thread is about the recipient but when it comes to prosecution, one thing must be taken into consideration.  Prosecutors and law authorities are "interested" but not reallyin recipients.  As wealthy as some may be and may have obviously broke some laws, they are small fish in the pan.  One recipient may get an organ, learn it may have been a terrible mistake and die/continue with other RRT.  It is usually a one time encounter with organ brokers unless the transplant was so successful (doubt it) that they refer other people in the same boat.  However, who law authorities really want is the brokers that organize these schemes and the medical professionals that go along with them too.  For example, a woman in Thailand recently got 15 years in prison as well as just 3 days ago ( 14 May 2015) Israel made a trafficking bust.   Obviously, the medical professionals would be wanted for ethical reasons as well as fraud.  Organs are like another other trafficked commodity; we all want to find the big cheese and bring them down with the illusion this will solve the problem.
 
All of this got me thinking and while my husband was boozing it up with some friends, I, the perpetual nerd, went through every journal article in my possession to see if I had anything especially relevant to this topic.  Good thing they were cataloged! There is an article that might explain a lot of this in the AMA Journal of Ethics called, "Transplant Tourism: Treating Patients when They Return to the U.S.".  An American gentleman had a successful transplant in China and as the article goes..:

"A month after his return to the United States, Mr. Lawrence ran out of the medications that his doctors in China had prescribed, including his immunosuppressants.."

"...so he made an appointment with Dr. Roberts, a nephrologist at a local academic center who specialized in care of renal transplant patients. Dr. Roberts was aware that many of the organs secured in China came from executed prisoners who did not always consent to organ donation. Further, Dr. Roberts was wary because purchasing organs was illegal in the U.S..."

"... Dr. Roberts understood how difficult it was to secure an organ, but didn't want to be perceived as condoning Mr. Lawrence's actions..."

Then, there is some commentary saying it is unethical to procure an organ in this way but a nephrologist states:

"In the nephrology community, my colleagues and I agree that the unspoken standard is to treat patients who have obtained organs overseas. Last year, the ethics committee of UNOS (United Network for Organ Sharing, the federally appointed agency charged with coordinating all organ donations and allocations), resolved that, while the individual physician does not have a duty to treat this type of patient in a nonemergency situation, the medical community as a whole does have such an obligation."

Futhermore...

"Some physicians, however, prefer not to treat a person who went abroad for an organ. Doing so, they believe, would make them complicit in organ trafficking. In such instances, the responsible course of action is for the physician to inform the patient of this position up front and, if the patient decides to pursue an organ overseas, refer him or her to a local colleague who is willing to provide follow-up care when he or she returns."

Again, I don't know about the American system and insurance.  However, I would assume that if there is a doctor that is willing to help you with full knowledge of how you received your new overseas organ, they would provide the applicable paperwork to insurance companies.  Take this with a grain of salt because I have noooooo idea how that works.  I just know here for insurance that my doctor fills out a load of paperwork and voila!

There is a lot of complicity and "looking the other way" in buying black market organs.  Some international organizations, even Interpol and the United Nations, believe that education of the matter will help solve the problem.  The pragmatists want to take the black market, remove the criminal element and create a market system out of the whole thing.  Either way, aftercare will remain a topic of discussion if there are organizational changes.  I'll shut up now. 

[MooseMom]

UT, thanks for that.  I guess the answer is to find a nephrologist who will look the other way and will prepare all of the necessary paperwork.  I suppose if it is not against US law to go overseas and legally (in that country) buy an organ, then whatever the US neph orders or prescribes isn't fraudulent.

Interesting. Again, thanks for doing the research as I am too lazy.  I'm going out to dinner instead!   

[PaulBC]

Just because a transaction is made out of desperation, does not mean it is not a "market transaction".  Real up on econ 101

Yes, of course it's a market. I'm pretty sure I had a point, though I agree I could have expressed it better.

There are serious problems with this market. On the supply side, you have people in the developing world who don't have anything close to a realistic understanding of what someone in the developed world pay for their kidney if they could (I claim this as fact, not imperialist condescension, but you don't have to agree). Even someone who does know could never sell it for that price because of so many others who will underbid them. On the demand side, you have extreme inelasticity. If you need a kidney, you'll gladly accept one for free, and you'll pay as much as you can if you have to.

I'm sure an economist could give a better description of a market like this, but it looks like exploitation to me. One problem is that the immediate benefit of a payment of several thousand dollars could look like a significant advantage to someone who has never seen that much money in their lives. But over the years, living with one kidney adds risks and potential medical expenses. In pure market terms, it may be a price determined by supply and demand, but it is not a fair price in the sense of reasonably compensating the donor for the true cost.

[Rerun]

I would think if they could afford to fly to a foreighn country and buy a kidney, they could afford to pay out of pocket for any doctor visit and any anti-rejection drug they would need back in the U.S.

Whoever said "Money can't buy happiness".... was poor.    

[Simon Dog]

Not all organ sales in foreign  countries are "criminal syndicates", however, the "American pays cash" inverts the supply/demand, so rather than the transplant center having many people for each kidney (and therefore, and incentive to select the patient who will boost the center's success rate), they have a surplus of kidneys for the paying patients - and thus an incentive to transplant even the most marginal match.

I would much rather rely on the motivation of a US based transplant center to boost it successful track record than the motivation of a foreign center to boost its cash flow.

The site is down, but BEK transplant of Shanghai used to have a web site where you could enter medical history and lab values to be evaluated for an executed prisoner kidkey.

[MooseMom]

I would think if they could afford to fly to a foreighn country and buy a kidney, they could afford to pay out of pocket for any doctor visit and any anti-rejection drug they would need back in the U.S.

But you see, that's the whole point.  An American who is desperate for a kidney can go to a foreign country and buy a kidney BECAUSE IT IS CHEAP.  You can buy a kidney in Bangladesh for $4,000.  And that's the genesis of my question.  The front end costs probably pale in comparison to the cost of the aftercare, but we never hear about the costs (or availability) of the aftercare, which is what I am asking about.

[PaulBC]

The front end costs probably pale in comparison to the cost of the aftercare, but we never hear about the costs (or availability) of the aftercare, which is what I am asking about.

Yeah, earlier you mentioned "the small army of people who support me and my tx needs" and that is what puzzles me as well. I would consider a black market transplant to be a shameful secret (and likely not a secret at all to any competent member of the care team). How would you find all the people to give you care you need, and how could you look them in the eye while discussing your transplant? (I'm not talking about the law; I'm taking about shame--has it been abolished?) Of course, anything probably beats dying if that's the alternative, but it seems that for most non-sociopaths, the ideal situation would be to have a legitimately obtained kidney and a care team they could be open with. Who is purchasing these kidneys? Are they really just rich, uncaring people? Do they have doctors who also don't give a rat's ass about the inhumanity of leaving behind a trail of suckers with chump change and a chronic medical condition? I'm not saying there aren't people like that, but it is really appalling. I'm not kidding or exaggerating when I refer to this as sociopathic behavior. In a kinder moment, I guess I'm willing to chalk it up to the banality of evil. Just don't worry about where that kidney came from. It is possible for a desperate or uneducated patient, but it is difficult to envision a competent medical infrastructure built on this principle.

[Simon Dog]

Lets talk some extreme examples:

1. Suppose a billionaire (think Gates/Jobs/Zuck) needs a kidney and offers to pay the 3rd world person living on $1 a day several tens of millions - an amount that will enable him and everyone remotely related to him to live like kings for the rest of their lives.   Is this immoral, or is only paying a small "absuive" amount?

2. What if a billionare needing a liver transplant (Jobs) gets listed at multiple transplant centers, and keeps a private jet on standby, thus giving him an advantage over others with less resources vying for a liver?   Remember, the fact that Jobs got his transplant means that someone else didn't.

3. What if the King of Saudi Arabia pays a commoner generously to be a "royal organ doner" - with up to date medical tests, traveling with the king, etc. as a source of spare parts?   Chances are he will never have to deliver but, if he does, all organs (heart, etc) are up for grabs.   How does this differ from paying a coal miner to take a chance on getting killed in return for money?   And no, this is not a theoretical example - a friend of mine oversaw building an OR in a 747 (and I don't think he was joking, when I googled him I found transcripts of his congressional testimony and reference to his position as a fortune 500 CEO).

This issue is only "simple" when you are not talking about paying the donor a life-changing amount of money.

And, there is a secondary issue - if a rich person buys an overseas kidney, that moves everyone after him/her up the list one place.

The US law against paying for organs is based on the principle of equality, and "from each according to his ability, to each according to his need".  Some guy names Marx tried that and we all know how that worked out. 

[MooseMom]

Simon Dog,

1.  Billionaires don't have to resort to going overseas for an organ because, like you've pointed out, they have the resources to legally obtain an organ more quickly and legally here in the US.  One can say that it's not fair that Steve Jobs got his transplant earlier than most people because he had that private jet to get him to any tx center he wanted, but that's not.  And since my question was really about after care, I'm assuming that he either had insurance or certainly had enough money to pay for any post-tx treatments out of pocket.  If a billionaire wanted to pay a third world citizen enough money that it would change his/her life forever, s/he could do that any day of the week.

2.  The fact that I got a transplant meant that someone else didn't.  The fact that ANYONE gets a transplant means that someone else didn't.  It's a function of not having enough organs to go around.

3.  I'm not sure what your point no. 3 means.  I imagine that the King of Saudi Arabia doesn't get his after care in the US and so does not have to worry about whether or not his insurance company would pay for post tx meds and such.

I don't know what Marx has to do with this.  I don't know how you would define "ability" (whether or not you have insurance?) and "need" (who needs a kidney the most?).

While extreme examples may be entertaining, they're not really informative.

Let me reframe my question:  Suppose the father of the young girl on PD in El Paso became so desperate to save her life that he emptied his savings accounts and remortgaged his house to pay to take her to, say, China, where he bought a kidney and had her undergo transplant surgery.  What would happen to her upon her arrival in the US, assuming that buying a kidney abroad is not breaking US law?  Would he simply take her back to her current US nephrologist, tell him/her what had happened, and then would the neph be able to prescribe meds and track her after care?  Would private insurance pay for care for a transplant patient who had received an organ abroad?  Does anyone know?  Would Medicare pay for this (if the patient had been claiming Medicare beforehand)? 

[PaulBC]

This issue is only "simple" when you are not talking about paying the donor a life-changing amount of money. 

I don't know of anyone who said the issue was simple. To be clear, I am not necessarily against people selling their kidneys. I am against people getting ripped off and selling their kidneys for too little, which is any amount that substantially understates the cost of future medical care. For some people, the cost might be minimal--you can live normally with one kidney. For others, it could be the cost of ESRD when their remaining kidney fails. I don't know the average amount, but I'm pretty sure $2500 (the amount quoted in a Kidneyville link) doesn't even come close. (Note that even if $2500 was close to the expected cost of living with one kidney, most people would prefer to be protected from catastrophic loss resulting from the failure of the remaining kidney. But an insurance policy would have to cost more than the expected cost to make any sense.)

By analogy, I am not against banks, but I am against loan sharks. I am not even against the notion of payday lenders in the abstract, but I believe that as currently practiced, they are abusive. Markets are often a good way to allocate resources, but markets with asymmetric information, not to mention asymmetric power relations, and asymmetric degrees of need, do not allocate resources efficiently. They move resources from the disadvantaged to the advantaged. If you believe markets are good because markets are good, then it is simple, but if you see markets as one of a portfolio of allocation tools, you have to acknowledge the reality of market failure.

The billionaire example. I don't have a huge problem with that. I am not even sure I find it morally distasteful, let alone unethical. Guarantee that you will take care of the donor, pay a price that reflects what the kidney is worth to you, the recipient, and it starts to look like a neutral commercial transaction (notwithstanding whether the medical ethics community agrees with me). When I was young, dare-devil Evel Knievel got lots of publicity putting his life at risk with motorcycle jumps. It looks stupid to me (and did at the time) but he was all grown up and understood the risks. No serious ethical issues there. If somebody wants to give up a kidney on a dare, that's probably OK too, but when an entire system is in place that exploits people who really don't want to give up their kidneys but lack other options that is not freedom of choice.

Wealthy people gaming the system. Meh. I'm not a huge fan but it's hard to see how to stop it. This is also a case of asymmetry. Laws can be made to apply to most people, but someone with enough resources can find loopholes. What I would ask is how many people are harmed in practice, and I think it is not that many. If I'm wrong, that is a failure to be addressed by changes in law.

And, there is a secondary issue - if a rich person buys an overseas kidney, that moves everyone after him/her up the list one place.

I agree that transplant candidates benefit marginally. The victim is the person getting cheated out of their health for a pittance. I agree that coal miners have historically been exploited in the way you described, and it's just as appalling. With sufficient safety measures, the risk and reward of hazardous occupations can be balanced, but often in the past it has not been.

The US law against paying for organs is based on the principle of equality, and "from each according to his ability, to each according to his need".  Some guy names Marx tried that and we all know how that worked out.

It's a rationing system, and I am the last person to claim it is either perfect or good. The mistake of totalitarianism is to use centralized planning as the primary means of resource allocation. That does not mean it is always the wrong way to allocate resources.

[PaulBC]

The US law against paying for organs is based on the principle of equality, and "from each according to his ability, to each according to his need".  Some guy names Marx tried that and we all know how that worked out. 

I want to get back to this, because it is not what the US system looks like.

Marx's adage taken literally would be something like compulsory donation for those with the best matching, healthiest kidneys, who seemed likely to suffer the least impact from donation. Give it a Soviet spin (or what I imagine it to be) and you would give them medals and put them on parade every year as national heroes.

Note that I do not advocate the above, merely pointing out what "from each according to his ability, to each according to his need" would really look like. (Sounds like a fun SF premise, but I think it would be incentive-distorting to say the least.)

[Simon Dog]

I want to get back to this, because it is not what the US system looks like.

You are correct in the extreme, but the US has implemented it to a lesser degree.

Kidneys are a valuable commodity, but are allocated based on central planning of a quasi-governmental body that decides what a "fair allocation" is, rather than letting the free market decide.  Isn't that how communism allocates housing, food, medical care, etc?

Wealthy people gaming the system. Meh. I'm not a huge fan but it's hard to see how to stop it.

Putting an end to listing at multiple centers would curtail the easiest way for big $$ to move themselves up the list.

[cattlekid]

I would hazard a guess (at least based on my experience) that it doesn't even take big $$ to move up the list by multi-listing.  My EGHP allowed me to go across state lines as long as I could get to their center in a reasonable amount of time and the center was on their list of "preferred" centers.  So theoretically, I could have listed at any clinic that had the best (shortest) list as long as I was willing to either move close by or have transportation on standby.  And I am by no means a 1%-er.

I contrast this with the woman whose husband owns a nail salon in our village.  She has been on PD for a little over a year and has listed with a local center because she only has Medicaid/Medicare.  Since Medicaid is state-based, she can't get away from the lengthy waiting list in Illinois.  I would never say that I "deserve" a kidney before her, but I was theoretically able to "buy" the ability to get a kidney before her due to my having EGHP that was portable. 

Wealthy people gaming the system. Meh. I'm not a huge fan but it's hard to see how to stop it.

Putting an end to listing at multiple centers would curtail the easiest way for big $$ to move themselves up the list.

[UkrainianTracksuit]

I am aware that not all transplant tourism is associated with criminal syndicates.  As I stated in my opening post, that has been the area of my professional and academic research so therefore that would be the slant of my understanding. 

I'm still trying to picture a Soviet transplant hero medal and parade.  Trust me, I've seen my share of Soviet medals and a few funky parades (before the collapse, naturally) and I'm quite intrigued at how this would have turned out.

Anyways, back to the original topic...

I know nothing about Medicare nor do I claim to have any knowledge about it.  However, does this answer your question?

“Additionally, Medicare will not cover the anti-rejection medications under Part B for people who have their transplants at a non-Medicare-approved facility creating financial hardships for the duration of the transplant.”    (Dianne B. McKay and Steven M. Steinberg in Kidney Transplantation: A Guide to the Care of Kidney Transplant Recipients published in 2010; a recent source.)

Patients are supposed to be informed of this. So, if a patient decides to remove themselves from the list in order to partake in transplant tourism, they must be aware that the costs for the continuous prescriptions afterwards must come out of their own pocket (or private insurance or the lucrative black market prescription world.)  I think the issue are those that see black market organs as a savior, not fully educated about aftercare concerns and end up poop stream (if you get my drift).

In a related manner, I. Cohen wrote, “In the U.S. system, regulators may have inadvertently already given the Centers for Medicaid and Medicare Services (CMS), which promulgates rules relating to the payment of those eligible for the Medicaid and Medicare public assistance programs, the power to do so.  As part of the informed consent process for patients seeking transplantation, patients must be informed that “if a transplant is not provided in a Medicare-approved transplant center it could affect the transplant recipient’s ability to have his or her immunosuppressive drugs paid for under Medicare Part B.”  (Patients with Passports, written in 2014)  He stated that he hasn’t found evidence of how often coverage is denied though.  I "think" there are some other articles that start some private insurance policies are another matter.  Some have covered post-care after patients have received an organ abroad.  I can't remember; I'm trying to aid in this thread and write analysis on a whole other topic at the same time.  Cohen stated that private insurance companies are more apt to prefer transplant tourism because it costs less than continuous dialysis.  (pg. 311)

As noted in the articles I referenced previously, yes, the example of the father in El Paso could take his daughter back to her regular nephrologist for care.  If that nephrologist felt it was ethically wrong to treat such a patient, he must inform her of a) a transplant clinic that will take her care/offer care b) provide her information on a nephrologist that is known to aid those that engaged in transplant tourism.  If his daughter was listed with a transplant clinic that dotted their i's and crossed their t's, the father would be aware that Medicare wouldn't cover aftercare of a foreign sourced kidney.  (Based upon the works aforementioned in this post.)  That would leave the father to source aftercare funding from private insurance willing to cover her case or personal funds.   

Hope that is a little bit helpful.  If even, just a tiny bit.

[MooseMom]

UT, you post DID have a lot of useful information!  Thank you!  I just assumed that Medicare wouldn't cover these costs for the very reasons your source stated, but I wasn't sure.

Thank you for taking the time to do a bit of research on this and to post your findings.  I appreciate it very much.

[MuddyGurl]

Dear Ms Tracksuit..I so appreciate your educated and pragmatic sharing of this information. It is such a shame that the gaining of an organ has become so mired in government control….we live in a culture that has zero respect for life as it begins, and protect death by suction as an enforced law..but allow the same gov. to tell us how we can live or not live without a needed kidney. Why?

Obviously the laws here are to protect the vulnerable and keep us  from becoming like China where a truck drives up beside you- a young healthy looking male say, and 24 minutes later the rolling kidney removal lab has divested you of your kidney, and placed you back on the street with an ice bag over the incision.

I don't know why there is no movement to allowing only US based citizen organ sharing programs, removing the option to take advantage of "poor 3rd worlders" as we all imagine them to be.  If Medicare won't cover post transplant treatment or meds then that is a severe restriction on going off to buy a kidney outside the borders.

But these same people may be fully prepared to sell their home, and take a second job and just pay for the meds as needed by the transplantee..their choice. 

And as the wave of boomers grows older..just the tip of the boomer spear are now over 65..and 10,000 A DAY, everyday for the next 19 YEARS will be turning 65!!!  that is a LOT of influence by the aging needy, for organs to save themselves. Remember these are the same citizens who voted Rowe vs Wade into law, and protected a woman's right to extreme birth control via needle aspiration or limb sectioning in a sterile environment. ( and please..rape or incest are not on the map as a percentage of 'need' for life removal.)   However you look at the need for birth control in the early 19th century, now with extensive choices for pregnancy protection resolved, how can we point to ethical restrictions between consenting donor and donee?

I dont believe their grey power will be ignored by  the gov. as they demand the right to life that have expected since childhood. Once enough with political power see the need to have a sane program of organ donation with financial support in a fair way..it may happen.

[Simon Dog]

how can we point to ethical restrictions between consenting donor and donee?

It is based on the same logic as laws regulating recreational drug use and banning suicide - the fundamental conclusion that the government, and not you, owns your body.