Transplant tourism can increase risk for organ recipients

When people languish on a wait-list for a kidney transplant, they may start to consider a desperate measure: Traveling to a country where they can buy a donor kidney on the black market.

But beyond the legal and ethical pitfalls, experts say, the health risks are not worth it.

Most countries ban the practice, sometimes called "transplant tourism," and it has been widely condemned on ethical grounds. Now a new study highlights another issue: People who buy a donor kidney simply do not fare as well.

Researchers in Bahrain found that people who traveled abroad to buy a kidney -- to countries like the Philippines, India, Pakistan and Iran -- sometimes developed serious infections.

Those infections included the liver diseases hepatitis B and C, as well as cytomegalovirus, which can be life-threatening to transplant recipients, the investigators said.

In addition, people who bought donor kidneys also faced higher rates of surgical complications and organ rejection, versus those who received a legal transplant in their home country.

Dr. Amgad El Agroudy, of Arabian Gulf University, was to present the findings Friday at the annual meeting of the American Society of Nephrology (ASN), in San Diego.

It's not clear how common it is for U.S. patients to take a chance on traveling abroad to buy a black-market kidney, according to Dr. Gabriel Danovitch, director of kidney transplantation at the University of California, Los Angeles.

"We really have no way of knowing what the numbers are," said Danovitch, who was not involved in the study.

"But," he added, "my sense is that the numbers are fairly small, as the dangers of transplant tourism are becoming more and more clear."

Why is it a risky proposition? According to Danovitch, there are a few broad reasons: The paid organ donors may not be properly screened, and the recipients may not be good candidates for a transplant, to name two.

"In a paid system, the prime focus is on making money," Danovitch said. "Centers that are willing to do these don't really care what happens to the donors or recipients after the transplant."

For people with advanced chronic kidney failure, the treatment options are dialysis or a transplant. But there are not enough donor organs to meet the need. In the United States, nearly one million people have end-stage kidney disease, and there are roughly 102,000 people on the waiting list for a transplant, according to the National Kidney Foundation.

Kidney transplants can come from a living or deceased donor, but living-donor transplants are more likely to be successful, according to U.S. health officials.

Ideally, Danovitch said, people find their own donor, often a family member or friend. Failing that, they go on the wait-list for a living or deceased donor organ.

Right now, the typical waiting time is nearly four years, according to federal government figures.

The donor-kidney shortage may only get worse, Danovitch said, due to high rates of obesity, high blood pressure and diabetes -- major risk factors for kidney disease.

Still, buying a kidney will never be a wise choice, according to Danovitch. "Unethical medicine is bad medicine," he said.

Dr. David Cohen, a professor at Columbia University Medical Center in New York City, agreed.

"Some patients might argue that staying on dialysis has risks, too," said Cohen, who is also a member of the ASN's Transplant Advisory Group.

"But the doctors and nurses who care for you at home are invested in your long-term well-being," Cohen said. "Over there [in a paid system], they're not. They're in it for the money. You'll do better in the long run if you stay on the waiting list for a transplant."

The findings are based on 270 Bahrain patients who traveled to another country to buy a donor kidney. El Agroudy's team compared them with 123 similar patients who received a transplant from a living donor, at the researchers' medical center.

Overall, patients who bought their organs had a higher rate of surgical complications, such as fluid buildup and obstruction in the ureters (the tubes that move urine from the kidneys to the bladder), the investigators found.

Those recipients' organs also had a shorter life span: After one year, 91 percent of those kidneys were still functioning, versus 98 percent of kidneys that were transplanted at the Bahrain hospital.

There are, of course, risks to the paid donors, too, Danovitch pointed out. They can also suffer infections and surgical complications, and in the long term they're at risk of deteriorating function in the remaining kidney.

Both he and Cohen encouraged kidney disease patients to stick with legal care in their home country.

"If you've been told you're not a candidate for a transplant, get a second opinion," Danovitch suggested.

But the reality, he added, is that a transplant is not a good option for some patients -- such as those who are in poor health because of co-existing medical conditions.

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.