The outcome of commercial kidney transplant tourism in Pakistan

Abstract

The lack of cadaver organs for transplantation motivates some Balkan patients to go to developing countries to buy a kidney. We have followed 36 patients who received kidney transplants in Lahore and Rawalpindi, Pakistan. The patients had not been cleared for transplantation with a standard pre-transplant work-up: 80% were hepatitis-C virus (HCV) or HBsAg positive. During follow-up, seven patients died. Sixteen patients experienced wound infections with post-operative hernias, and three patients developed peri-renal hematomas. Six abscesses and four lymphoceles occurred, and four urinary fistulas were surgically treated. Nephrectomy was performed in three patients because of renal artery thrombosis. Nine patients developed active hepatitis C, and four patients manifested cytomegalovirus disease. Three patients developed steroid diabetes, and three patients experienced acute myocardial infarction. Nine patients had one or more rejection episodes. Urinary tract infection with Pseudomonas or Escherichia occurred frequently. The one-yr patient and graft survival rates were 80% and 68%, respectively. Paid unregulated renal transplantation is not recommended for both ethical reasons and because of an association with excessive morbidity and mortality.

Key issues in transplant tourism

“…In addition to ethical reasons, concern about paid unregulated renal transplantation is due to the associated excessive morbidity and mortality, for example, in one study seven of 36 commercial transplants performed in India and Pakistan during 2006-2007 died within 2 mo of transplantation [41] . It is important that accurate data on outcomes of transplants carried out abroad are known so that patients can be counselled about such activity [24,42] .…”

“…It is important that accurate data on outcomes of transplants carried out abroad are known so that patients can be counselled about such activity [24,42] . The outcome of recipients of organs through TT is reported to be inferior to those transplanted under ethically more acceptable conditions (Table 2) [5,6,23,25,[41][42][43][44][45][46][47][48][49][50][51][52][53][54] .…”

“…Transplant tourists have a more complex post-transplantation course with higher infectious complications including the transmission of HIV and hepatitis B and C viruses [5,23,25,41,46,53,55] . The Dubai experience with 45 paediatric renal allograft transplantations performed outside the United Arab Emirates between 1993 and 2009 is sown in Table 2.…”

Cadaver Transplantation in Balkans: Mission Possible?

“…The lack of cadaveric organs for transplantation motivates some Macedonian patients, as well as patients from other Balkan,countries to buy a kidney for example from developing countries [1]. There have been attempts to compare combined data from the national renal registries of Balkan countries with combined data from renal registries of the Western and Northern European Countries and regions contributing the ERA-EDTA Registry [2].…”

Bivalent live poliovirus vaccine: A blessing or a curse

“…Seven of them died while 16 developed wound infections, and there were 7 transplant rejection episodes. 5 There could be several post-transplant recipients who would be sero-negative to one or more poliovirus serotypes in polio endemic countries.…”