Checklist: Passport, Plane Ticket, Organ Transplant

K. A. Bramstedt; Jun Xu

Disclosures

American Journal of Transplantation. 2007;7(7):1698-1701. 

In This Article

Coercive Insurance

In the US, IndUShealth (http://www.indushealth.com) partners with Global Health Administrators, Inc., working with corporations and insurance companies to arrange for US residents to obtain living donor organ transplants in India. In these cases, the donor is identified in the US and travels with the recipient patient to India. Prior to donation, the potential donor's physician, the IndUShealth Medical Director, and the Indian transplant team evaluate the candidate with the assistance of video conferencing as needed. Indian citizens are not permitted to be living donors for IndUShealth patients (Tom Keesling, personal communication. IndUShealth, Raleigh, NC, September 2006). Hospitals with IndUShealth referral arrangements include Max Heart, which offers heart transplantation in Saket, India; Wockhardt Hospital, which offers kidney transplantation in Kolkata, India; and Apollo Hospital, which offers liver and kidney transplants in New Delhi.

Another company United Group Programs, Inc. (http://www.ugpinc.com) offers living and deceased donor transplants by way of organ tourism. In the case of living donation, the donor can be identified in the foreign country and evaluated by clinicians at the overseas hospital (Jonathan Edelheit, personal communication. United Group Programs, Boca Raton, FL, September 2006). Heart, lung, liver, and kidney transplants are performed at their referral facility, Bumrungrad International (Bangkok, Thailand). For both companies, organ tourism is optional, not mandated to receive insurance coverage (policy holders may choose to undergo transplantation in the US). Currently, United Group Programs has about 40 employers who offer this health plan to their employees.

In February 2006, two healthcare tourism proposals were submitted to the West Virginia legislature. Specifically, House Bill 4359 would establish a formal healthcare tourism system for West Virginia public employees. These employees would be allowed to travel overseas for medical care with treatment costs paid, a waiver of all copayments and deductibles, payment of airfare and lodging for the employee and one companion, and a rebate of 20% of the cost savings back to the employee.[14] Similarly, House Bill 4711 would create a system for use by private insurance companies. The provisions of the bill are identical to that of House Bill 4359, including a rebate of 20% of the cost of the savings back to the insured patient.[15] Both bills are voluntary in that patients would not be required to obtain their medical care overseas if the treatment costs were less than in the US. Nonetheless, the 20% rebate offered by these programs could be viewed as coercive, especially in West Virginia, a state with over 15% of its residents living in poverty.[16]

As written, both proposals do not exclude overseas organ transplants thus their rebate plans potentially foster transplant tourism. Currently, both bills are pending in the legislature; however, if they pass and realize financial benefit to West Virginia, other States could follow with similar legislation, paving additional paths to transplant tourism. Also, "legal" acceptance of such tourism could be viewed by some as equivalent to an ethical endorsement (the argument being, if it is legal, it can't be unethical).

Contrary to the West Virginia proposals, Belgium is considering making some organ tourism illegal.[17] Specifically, Belgium senator (and physician) Patrik Vankrunkelsven has proposed legislation that would allow the King of Belgium to create a list of non-European Union hospitals that are ethically acceptable for organ transplantation. Hospitals placed on this list would be those which ensure informed consent from organ donors and do not allow organ donation from condemned prisoners. Those who undergo transplantation at non-European Union hospitals that are not on the approved list are subject to a fine of €500 to €5000.

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