Checklist: Passport, Plane Ticket, Organ Transplant

K. A. Bramstedt; Jun Xu

Disclosures

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

In This Article

Conclusions

The high cost of healthcare and the shortage of donor organs in the US set the stage for insurance policies that promote organ tourism. We, however, see multiple potential victims of such practices, namely the living organ donor, the recipient, and potentially, overseas resident patients awaiting transplant. Even if organ tourism insurance applies only to deceased donor transplants, there is the matter of transferring organs away from the resident community to overseas travelers without any regulation. Consistent with countries such as Australia and New Zealand, there should be a system of two waiting lists which allocates organs first to residents, then to nonresidents ("guests" of the transplant community). As guests in a foreign country, these individuals should not be on an equal playing field for access to allografts, but rather they should have access only after it has been determined that no suitable allocation can be made to a resident.[35]

While the programs described in this article may make transplantation available in a manner that is faster (shorter waiting times) and cheaper, they are ethically troublesome in that they create a coercive environment to patients and foster the practice of transplant tourism (which exploits living donors and disregards the needs of resident patients in foreign countries). Faced with the prospect of clinical deterioration, death, and high costs, transplant tourism could be enticing to some US patients. When employers add financial bonuses, this can increase the temptation to participate. Another concept to consider is pressure (subtle or not) placed on employees by their employers to participate in organ tourism as a condition of retaining employment and/or insurance coverage. It remains to be seen how employees who reject organ tourism are treated by their employers with regard to employment, promotions, and compensation.

Increasing transplant availability is a worthy goal, but transplant tourism is not an ethical approach. We support the work of the Organ Donor and Transplant Breakthrough Collaborative and their efforts toward transplant centre and organ procurement organization (OPO) process improvement.[36] Maximizing organ donation through education, reducing missed opportunities, and efficient processes are all ethically appropriate methodologies. Process improvement can also potentially have a positive impact on organ quality. Additionally, appropriate use of extended criteria organs is also an ethically acceptable way of increasing transplant availability.[37]


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