Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, April 17, 2016

Transplant Tourism : Risky Behaviour

"If patients are told it's a crime, that might curtail people going abroad. It's definitely frustrating. Patients never express any kind of regret for having done what they did, even when they're very sick."
". . . They're so convinced they did the right thing for themselves."
Dr. Ramesh Prasad, nephrologist, St. Michael's Hospital, Toronto

"We have in the past said, 'Our relationship with that patient is tarnished'. That creates a bit of an awkward situation, and the last thing  you want to do is compromise patient care because of hard feelings between the doctor and patient."
Dr. Jag Gill, transplant nephrologist, St.Paul's Hospital, Vancouver 
The blame for overseas transplant surgeries gone awry likely goes to poor surgical techniques, infection and inadequate matching with the donor at the time of the original operation, experts say.
Christopher Furlong/Getty Images    The blame for overseas transplant surgeries gone awry likely results from poor surgical techniques, infection and inadequate matching with the donor at the time of the original operation
And so, sometimes diplomacy is required and practised to ensure that such 'hard feelings' do not indeed compromise patient care. As, for example, when an expert in the field of transplant has been approached by a patient making enquiries about the possibility of seeking a transplant abroad; effectively 'buying' a body part, and travelling to foreign parts to have a transplant done there, and the Canadian doctor advises against it, and is later confronted by that same patient returning for treatment after a botched transplant that took place abroad.

Canada does have a problem. The wait times for transplant operations are entirely geared to the availability of transplant organs, whether from cadavers or from live donors. Simply put there are too many people requiring life-or-death transplants, and too few donated organs to serve the needs of those whose health has been so critically compromised. And so, those who can afford the expense of travelling abroad to countries like China, Pakistan or India, to 'buy' an organ and undergo transplant, will do so out of desperation that time is running out for them.

In the same token what they are doing can often further exacerbate their longevity prognosis. At the very least, the success of the transplant surgery they have undertaken. When research definitely indicates that such surgeries undertaken in those countries can be of inferior quality so that the organ fails, and death can ensue. In any event, patients who do take that route as transplant tourists arrive back in Canada and then require the kind of follow-up treatment that does not take place where the transplant took place.

Aside from the fact that trade in transplants falls into a morally questionable cesspool of where the organ comes from: in China prisoners of the state; in India and Pakistan poverty stricken people who need the money gained from selling an organ, or from any kind of involuntarily harvested organ situation of people who have been kidnapped and then released minus a valuable organ, people arriving from Canada to such destinations are placing their own lives at risk. Improper organ matches and blood types, follow-up care, inadequate infection control, can all have devastating consequences.

Often enough, people who have undergone a kidney transplant (the most common type of organ transplant) outside of Canada return expecting after care, bringing with them potentially deadly infections of hepatitis and tuberculosis, according to a study headed by Dr. Prasad. Dr. Gill in Vancouver points out that if a patient who has been warned against it returns from an organ transplant outside the country, his hospital will refer the patient for care to another hospital to avoid the potential for hard feelings between doctor and patient.

Research has indicated that poor short-term results of commercial kidney grafts taking place abroad are all too common. The St.Michael's Hospital study, published in he journal Kidney International,  shows that patients who manage to survive the initial months post-transplant fare badly on an ongoing basis, up to eight years after taking possession of their bought organ. That is directly attributable to poor surgical techniques, infection and improper matching of the donor to the recipient at the time of the operation.

Needless to say, Canadians returning from those trips abroad as transplant tourists can always be assured that their ongoing medical treatment will continue at any Canadian hospital they are admitted to. This most recent study investigated 69 people over a longer, eight-year period who had gone abroad for transplants, finding they continued to experience loss of the organ and death at  higher rates than those of domestic organ recipients.

Of the commercial-transplant patients, about 20 percent died by the end of eight years while about 30 percent had lost their bought kidneys, representing a rate three to four times higher than among domestic recipients. Moreover, having an organ fail and then requiring a replacement places patients in a more compromised position, as discovering a suitable match a second time around becomes more complicated, according to Dr. Prasad.

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