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Organ trafficking, transplant tourism, and transplant commercialism

Author
John Vella, MD, FACP, FRCP, FASN
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Most countries in the Western world prohibit compensated organ donation. Within the United States, the National Organ Transplant Act of 1972 states, "It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation." Penalties include a fine of up to USD $50,000 and/or imprisonment for up to five years.

Although condemned by the international community, organ trafficking, transplant tourism, and commercial transplantation are likely here to stay. Patient desperation, which is driven by the disparity between organ supply and demand, finds an outlet in unregulated countries. It is important to remember that, compared with dialysis, transplantation is the best treatment for end-stage renal disease (ESRD).

Evidence indicates that healthcare practitioners who support organ trafficking and transplant tourism often dispense substandard care. Another concern is the risk of morbidity and mortality experienced by the living donors who are preyed upon by unscrupulous centers.

This topic review will address some of the current issues affecting the international transplant community that threaten to undermine altruistic organ donation and transplantation. The discussion will include the related issues of organ trafficking, transplant tourism, and transplant commercialism.

EPIDEMIOLOGY

The actual number of transplants resulting from organ trafficking, transplant tourism, and transplant commercialism is largely unknown. Some estimate that organ trafficking may account for 5 and 10 percent of all kidney transplants [1].

        

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Literature review current through: Nov 2016. | This topic last updated: Wed Dec 16 00:00:00 GMT 2015.
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References
Top
  1. Budiani-Saberi DA, Delmonico FL. Organ trafficking and transplant tourism: a commentary on the global realities. Am J Transplant 2008; 8:925.
  2. Merion RM, Barnes AD, Lin M, et al. Transplants in Foreign Countries Among Patients Removed from the US Transplant Waiting List. Am J Transplant 2008; 8:988.
  3. Kovac C. Kidney trafficking is "big business," says Council of Europe. BMJ 2003; 327:249.
  4. Kumar S. Police uncover large scale organ trafficking in Punjab. BMJ 2003; 326:180.
  5. International Summit on Transplant Tourism and Organ Trafficking. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Clin J Am Soc Nephrol 2008; 3:1227.
  6. Ghods AJ, Nasrollahzadeh D. Transplant tourism and the Iranian model of renal transplantation program: ethical considerations. Exp Clin Transplant 2005; 3:351.
  7. Hussein MM, Mooij JM, Roujouleh H, el-Sayed H. Commercial living-nonrelated renal transplantation: observations on early complications. Transplant Proc 1996; 28:1941.
  8. Mansy H, Khalil A, Aly TF, et al. Outcome of commercial renal transplantation: two years follow-up. Nephron 1996; 74:613.
  9. Frishberg Y, Feinstein S, Drukker A. Living unrelated (commercial) renal transplantation in children. J Am Soc Nephrol 1998; 9:1100.
  10. Mourani CC, Mallat SG, Karam PE. Mycotic aneurysm after commercial kidney transplantation. Pediatr Nephrol 1999; 13:630.
  11. Ben Hamida F, Ben Abdallah T, Goucha R, et al. Outcome of living unrelated (commercial) renal transplantation: report of 20 cases. Transplant Proc 2001; 33:2660.
  12. Sever MS, Kazancioğlu R, Yildiz A, et al. Outcome of living unrelated (commercial) renal transplantation. Kidney Int 2001; 60:1477.
  13. Prasad GV, Shukla A, Huang M, et al. Outcomes of commercial renal transplantation: a Canadian experience. Transplantation 2006; 82:1130.
  14. Canales MT, Kasiske BL, Rosenberg ME. Transplant tourism: Outcomes of United States residents who undergo kidney transplantation overseas. Transplantation 2006; 82:1658.
  15. Gill J, Madhira BR, Gjertson D, et al. Transplant tourism in the United States: a single-center experience. Clin J Am Soc Nephrol 2008; 3:1820.
  16. Tsai MK, Yang CY, Lee CY, et al. De novo malignancy is associated with renal transplant tourism. Kidney Int 2011; 79:908.
  17. Tsai HL, Chang JW, Wu TH, et al. Outcomes of kidney transplant tourism and risk factors for de novo urothelial carcinoma. Transplantation 2014; 98:79.
  18. Sun CY, Lee CC, Chang CT, et al. Commercial cadaveric renal transplant: an ethical rather than medical issue. Clin Transplant 2006; 20:340.
  19. International Summit on Transplant Tourism and Organ Trafficking. The Declaration of Istanbul on organ trafficking and transplant tourism. Kidney Int 2008; 74:854.
  20. Steering Committee of the Istanbul Summit. Organ trafficking and transplant tourism and commercialism: the Declaration of Istanbul. Lancet 2008; 372:5.
  21. Participants in the International Summit on Transplant Tourism and Organ Trafficking Convened by the Transplantation Society and International Society of Nephrology in Istanbul, Turkey, April 30-May 2, 2008. The Declaration of Istanbul on organ trafficking and transplant tourism. Transplantation 2008; 86:1013.
  22. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Istanbul Summit April 30-May 2, 2008. Nephrol Dial Transplant 2008; 23:3375.
  23. Delmonico FL. The development of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Nephrol Dial Transplant 2008; 23:3381.
  24. Yang RC, Thiessen-Philbrook H, Klarenbach S, et al. Insurability of living organ donors: a systematic review. Am J Transplant 2007; 7:1542.
  25. Danovitch GM, Chapman J, Capron AM, et al. Organ trafficking and transplant tourism: the role of global professional ethical standards-the 2008 Declaration of Istanbul. Transplantation 2013; 95:1306.
  26. Salomon DR, Langnas AN, Reed AI, et al. AST/ASTS workshop on increasing organ donation in the United States: creating an "arc of change" from removing disincentives to testing incentives. Am J Transplant 2015; 15:1173.
  27. Glazier AK, Danovitch GM, Delmonico FL. Organ transplantation for nonresidents of the United States: a policy for transparency. Am J Transplant 2014; 14:1740.