Organ Trafficking and Transplant Tourism

Danovitch, Gabriel M.; Chapman, Jeremy R.; Capron, Alexander Morgan; Levin, Adeera; Abbud-Filho, Mário; Mousawi, Mustafa Al; Bennett, William M.; Budiani-Saberi, Debra; Couser, William G.; Dittmer, Ian; Jha, Vivekanand; Lavee, Jacob; Martin, Dominique; Masri, Marwan; Naicker, Saraladevi; Takahara, S; Tibell, Annika; Shaheen, Faissal A.M; Vathsala, A.; Delmonico, Francis L.

doi:10.1097/tp.0b013e318295ee7d

Cited by 93 publications

(22 citation statements)

References 20 publications

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“…No systematic changes in donors' and recipients' selection criteria, surgical or medical equipment, or surgical and monitoring procedures were introduced throughout the study. The study was run according to the Declaration of Helsinki guidelines and the principles of the Declaration of Istanbul as outlined in the ‘Declaration of Istanbul on Organ Trafficking and Transplant Tourism' [19] and was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement [20.] Data were recorded in dedicated case report forms and then doubly entered.…”

Section: Methodsmentioning

confidence: 99%

Low-Dose RATG with or without Basiliximab in Renal Transplantation: A Matched-Cohort Observational Study

et al. 2015

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Background/Aims: In renal transplantation, peri-operative low-dose rabbit-antithymocyte-globulin (RATG) plus basiliximab induction prevented acute allograft rejection more effectively than post-operative RATG plus basiliximab induction. We investigated the specific antirejection contribution of basiliximab in this context. Methods: This single-center, observational, matched-cohort study evaluated allograft rejections (primary outcome), steroid exposure and side effects, GFR (iohexol plasma clearance) and treatment costs in 16 deceased-donor renal transplant recipients induced with RATG (0.5 mg/kg/day) and 32 age-, gender- and treatment-matched reference-patients given RATG plus basiliximab (20 mg on days 0 and 4). Results: Induction was well tolerated. At 18 months, 8 patients (50%) vs. 3 reference-patients (9.4%) rejected the graft [HR (95% CI): 6.53 (1.73-24.70), p = 0.006]. Difference was significant (p < 0.01) even after adjusting for recipient/donor age and gender, cold ischemia time and HLA mismatches. There were 1 antibody-mediated rejection and 2 moderate cellular rejections in patients vs. none in reference-patients (p = 0.032). The median (interquartile range) prednisone cumulative dose was remarkably higher in patients than reference-patients [4.78 (1.12-6.10) vs. 0.19 (0.18-3.81) grams, p = 0.002]. Three patients vs. 24 reference-patients were off-steroid at study end (p < 0.001). Three patients vs. no reference-patient developed new-onset diabetes (p = 0.003). Both inductions similarly depleted B-cells. Outcomes of AZA- vs. MMF-treated participants were similar. GFR was similar in all groups. Compared to MMF, AZA therapy saved ≈ EUR 2,500/year and by month 14.3 post-transplant compensated basiliximab costs. Conclusion: In renal transplantation, basiliximab plus peri-operative low-dose RATG more efficiently prevented allograft rejection than RATG monotherapy, and minimized steroid exposure and toxicity. AZA- vs MMF-based maintenance immunosuppression largely compensated the extra costs of basiliximab.

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Section: Methodsmentioning

confidence: 99%

Low-Dose RATG with or without Basiliximab in Renal Transplantation: A Matched-Cohort Observational Study

et al. 2015

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“…Unlike the several ethical concerns currently casting a shadow over allotransplantation in some countries, e.g., paid living organ donation (39, 40), the use of organs from prisoners after execution (39, 41), there should be no ethical concerns with regard to using pigs for this purpose. In the US, approximately 100 million pigs are slaughtered each year for food, and in China it is estimated that approximately 600 million pigs are sources of heparin for the world annually.…”

Section: Tablementioning

confidence: 99%

The case for xenotransplantation

Cooper

2015

Clinical Transplantation

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The availability of organs and cells from deceased humans for transplantation is not meeting the demand. Xenotransplantation, specifically the transplantation of organs and cells from genetically-engineered pigs, could resolve this problem. Diabetic monkeys have remained normoglycemic and insulin-independent after pig islet transplantation for >1 year, and a pig heterotopic (non-life-supporting) heart transplant recently reached the one-year milestone in a baboon. With these encouraging results, why is it that, with some notable exceptions, research into xenotransplantation has received relatively little support by industry, government funding agencies, and medical charitable foundations? Industry appears reluctant to support research that will take more than 2–3 years to come to clinical trial, and the funding agencies appear to have been “distracted” by the current appeal of stem cell technology and regenerative medicine. It has only been the willingness of living donors to provide organs that has significantly increased the number of transplants being performed worldwide. These altruistic donations are not without risk of morbidity and even mortality to the donor. Although with the best of intentions, we are therefore traversing the Hippocratic Oath of doctors to “do no harm”. This should be a stimulus to fund exploration of alternative approaches, including xenotransplantation.

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“…The declining rate of deceased donor transplantation observed in east Asia was driven by reduced activity in China. Pakistan signed into law the Ordinance on Human Cell and Tissue Transplantation in 2010, thus criminalizing organ sales 21 . The Philippines implemented an expanded anti-human trafficking law in 2009 21 .…”

Section: Trends In Transplantation Activitiesmentioning

confidence: 99%

“…Pakistan signed into law the Ordinance on Human Cell and Tissue Transplantation in 2010, thus criminalizing organ sales 21 . The Philippines implemented an expanded anti-human trafficking law in 2009 21 . Parallel efforts to curb transplant tourism by major exporters of recipients have also influenced these trends 22 .…”

Section: Trends In Transplantation Activitiesmentioning

confidence: 99%

The global diffusion of organ transplantation: trends, drivers and policy implications

White

Hirth

Mahíllo

et al. 2014

Bull. World Health Organ.

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104

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Rising incomes, the spread of personal insurance, lifestyle factors adding to the burden of illness, ageing populations, globalization and skills transfer within the medical community have increased worldwide demand for organ transplantation. The Global Observatory on Donation and Transplantation, which was built in response to World Health Assembly resolution WHA57.18, has conducted ongoing documentation of global transplantation activities since 2007. In this paper, we use the Global Observatory’s data to describe the current distribution of – and trends in – transplantation activities and to evaluate the role of health systems factors and macroeconomics in the diffusion of transplantation technology. We then consider the implications of our results for health policies relating to organ donation and transplantation. Of the World Health Organization’s Member States, most now engage in organ transplantation and more than a third performed deceased donor transplantation in 2011. In general, the Member States that engage in organ transplantation have greater access to physician services and greater total health spending per capita than the Member States where organ transplantation is not performed. The provision of deceased donor transplantation was closely associated with high levels of gross national income per capita. There are several ways in which governments can support the ethical development of organ donation and transplantation programmes. Specifically, they can ensure that appropriate legislation, regulation and oversight are in place, and monitor donation and transplantation activities, practices and outcomes. Moreover, they can allocate resources towards the training of specialist physicians, surgeons and transplant coordinators, and implement a professional donor-procurement network.

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Organ Trafficking and Transplant Tourism

Cited by 93 publications

References 20 publications

Low-Dose RATG with or without Basiliximab in Renal Transplantation: A Matched-Cohort Observational Study

Low-Dose RATG with or without Basiliximab in Renal Transplantation: A Matched-Cohort Observational Study

The case for xenotransplantation

The global diffusion of organ transplantation: trends, drivers and policy implications

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