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    Steering Clear of Organ Tourism

    “Foreigners OK” and “no waiting period” are examples of lures used by overseas transplant centers in an attempt to divert U.S. patients to their hospitals. Indeed, the desperation of some patients has led them to venture to an international location in order to undergo organ transplantation. This practice, commonly known as “transplant tourism,” carries risks and ethical issues that need to be considered by patients, families and U.S. healthcare teams.

    Lack of Informed Consent

    It is widely known that some organs transplanted at overseas hospitals originate from people who were not able to give informed consent. There are many situations in which this can occur. Some examples in countries such as China, India, Pakistan and the Philippines include:

    • forced donation from prisoners

    • forced donation from spouses

    • donation from those who are uneducated and unable to understand the risks and consequences, and

    • living donation from the poor who see it as a way of generating income to meet their daily needs.
    In the U.S., informed consent is highly valued and imperative to our transplant process; however, not all countries share this value.

    Minimal Safeguards for Living Donors

    Similarly, in the U.S., the safety of living donors is very important and transplant centers have a donor advocate to ensure the donor’s safety, welfare and informed consent. It is not clear that countries outside of the U.S. have such safeguards for their living donors.

    Be Cautious When Looking Overseas

    Another fact to consider is that overseas transplant programs may have looser criteria for accepting patients onto their transplant waiting lists. This might seem like a good idea; however, looser criteria can also mean giving patients and families false hope for transplant success. In the U.S., when a patient is declined for placement on the organ waiting list, this is because it has been determined that the patient will not benefit from transplant. Patients looking overseas for transplant opportunities should be very cautious about centers promising good outcomes for patients who actually will not benefit from transplant.

    Transplant teams sometimes encounter patients who have participated in organ tourism, then seek post-transplant care in the U.S. This can cause great ethical discomfort. Legally and ethically, caregivers have the right to abstain from caring for these patients unless the situation is an emergency.

    At California Pacific Medical Center, we strongly discourage patients from participating in organ tourism. While we are frustrated by the U.S. donor organ shortage, we are ethically troubled by the practice of organ tourism and do not want to support any efforts that might encourage these practices. If you are a patient who has been waiting a long time for organ transplantation (or family of someone waiting) we encourage you to discuss your transplant options with us.

    article published in October 2007 Kidney Review newsletter. Authored by Katrina A. Bramstedt, Ph.D., clinical ethicist

    About California Pacific Medical Center

    California Pacific Medical Center, part of the Sutter Health network, offers kidney, pancreas, liver and heart transplantation as part of our Barry S. Levin, MD Department of Transplant.

    Kidney & Pancreas Transplant Program
    California Pacific Medical Center
    2340 Clay Street
    San Francisco, CA 94115
    Tel. 415-600-1700

    Outreach locations available throughout Northern California and in Reno.