As the U.S. waiting list for kidney transplants grows, and with it the potential for longer waiting times, so might the temptation among end-stage renal disease patients to travel abroad for a transplant. So-called transplant tourism is not looked upon favorably by a group of nephrologists who held a summit recently in Istanbul to address this and related issues. Out of the summit came the "Declaration of Istanbul," in which summit participants concluded that "transplant commercialism, which targets the vulnerable, transplant tourism, and organ trafficking should be prohibited." Provisions of this declaration appear in the Clinical Journal of the American Society of Nephrology (2008;3:1227-1231).
In a study published in the American Journal of Transplantation (2008;8:988-996), researchers observed that the number of individuals who were removed from a U.S. transplant wait list and acquired a transplant aboard increased between 2001 and 2006. In my view, it is not ethically wrong for Americans to travel to another country for a transplant, but it is ethically wrong for them to buy organs in nations without organ- purchase regulations because it contributes to the exploitation of the economic underclass. People desperate for money may see selling a kidney as a way out of their financial problems and not give adequate consideration to the potential consequences.
Nephrologists who know of patients planning to go abroad for a transplant should explain the added medical risks. The United States has rigorous donor selection and screening criteria that might not exist in foreign countries, especially developing nations. In places where health-care infrastructure and medical standards of care may be inferior to that of the United States, how can transplant tourists know for sure if the organ they are getting is in good condition or an appropriate match, or if the donor is free of an infectious disease that is transmissible via organ transplant?
In a study scheduled for publication in the Clinical Journal of the American Society of Nephrology, researchers found that U.S. residents who travel abroad to receive kidney transplants experience more severe post-transplant complications and a high incidence of acute rejection and severe infections compared with patients who undergo transplantation in the United States.
The "Declaration of Istanbul" is an admirable step toward preventing exploitation of would-be donors in foreign lands. Governments around the world, especially in popular transplant tourism destinations, should at least consider its provisions and objectives.