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Al Riyami MS, Al Saidi S, Al Ghaithi B, Al Maskari A, Lala S, Mohsin N, Hirshikesan L, Al Kalbani N. Pediatric Renal Transplantation in Oman: A Single-center Experience. Oman Med J 2018; 33:7-14. [PMID: 29467993 DOI: 10.5001/omj.2018.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objectives This study sought to report 22 years experience in pediatric kidney transplantation in Oman. Methods Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation (including surgical complications, infections, graft rejection) graft and patient survival, and duration of follow-up. Results During the study period transplantation from 27 living related donors (LRDs), 42 living unrelated donors (LURDs), also referred to as commercial transplant, and one deceased donor were performed. The median age at transplantation was nine years for both groups. The most common primary diagnosis was congenital anomalies of the kidney and urinary tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal transplantation. Children who received LURD kidneys had high surgical complications (42.8%) compared to the LRDs group (17.8%). Five patients from LURDs group had early graft nephrectomy and four patients developed non-graft function or delayed graft function. In addition, patients in the LURDs group had a higher incidence of hypertension and acute rejection. Graft and patient survival were both better in the LRDs than the LURDs group. Conclusions Although our pediatric kidney transplant program is a young program it has had successful patient outcomes comparable to international programs. Our study provides evidence that in addition to legal and ethical issues with commercial transplant, it also carries significantly higher morbidity and reduced graft and patient survival.
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Affiliation(s)
- Mohamed S Al Riyami
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Sulaiman Al Saidi
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Badria Al Ghaithi
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Anisa Al Maskari
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Sadiq Lala
- Urology Unit, Department of Surgery, Royal Hospital, Muscat, Oman
| | - Nabil Mohsin
- Department of Medicine, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Lekha Hirshikesan
- Department of Nephrology Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Naifain Al Kalbani
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
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Ambagtsheer F, de Jong J, Bramer WM, Weimar W. On Patients Who Purchase Organ Transplants Abroad. Am J Transplant 2016; 16:2800-2815. [PMID: 26932422 DOI: 10.1111/ajt.13766] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/25/2023]
Abstract
The international transplant community portrays organ trade as a growing and serious crime involving large numbers of traveling patients who purchase organs. We present a systematic review about the published number of patients who purchased organs. With this information, we discuss whether the scientific literature reflects a substantial practice of organ purchase. Between 2000 and 2015, 86 studies were published. Seventy-six of these presented patients who traveled and 42 stated that the transplants were commercial. Only 11 studies reported that patients paid, and eight described to what or whom patients paid. In total, during a period of 42 years, 6002 patients have been reported to travel for transplantation. Of these, only 1238 were reported to have paid for their transplants. An additional unknown number of patients paid for their transplants in their native countries. We conclude that the scientific literature does not reflect a large number of patients buying organs. Organ purchases were more often assumed than determined. A reporting code for transplant professionals to report organ trafficking networks is a potential strategy to collect and quantify cases.
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Affiliation(s)
- F Ambagtsheer
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J de Jong
- Analysis and Research Department, Central Division of the National Police, Driebergen, the Netherlands.,Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W Weimar
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Rodríguez-Reimundes E, Soler-Pujol G, Díaz CH, Dávalos-Michel M, Jost LJ, Laham G, Vilches AR. Travel for transplantation and transplant commercialism in Argentina: a 4-decade experience from a University Hospital. Clin Transplant 2014; 28:377-82. [DOI: 10.1111/ctr.12323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Ezequiel Rodríguez-Reimundes
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Gervasio Soler-Pujol
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Carlos H. Díaz
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Mario Dávalos-Michel
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Luis J. Jost
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Gustavo Laham
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Antonio R. Vilches
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
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Anker AE, Feeley TH. Estimating the risks of acquiring a kidney abroad: a meta-analysis of complications following participation in transplant tourism. Clin Transplant 2012; 26:E232-41. [DOI: 10.1111/j.1399-0012.2012.01629.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Ashley E. Anker
- Department of Communication; University of Buffalo; The State University of New York; Buffalo; NY; USA
| | - Thomas H. Feeley
- Department of Communication; University of Buffalo; The State University of New York; Buffalo; NY; USA
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Kapoor A, Kwan KG, Whelan JP. Commercial renal transplantation: A risky venture? A single Canadian centre experience. Can Urol Assoc J 2011; 5:335-40. [PMID: 22031615 DOI: 10.5489/cuaj.11018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Canada, akin to other developed nations, faces the growing challenges of end-stage renal disease (ESRD). Even with expanded donor criteria for renal transplantation (the treatment of choice for ESRD), the supply of kidneys is outpaced by the escalating demand. Remuneration for kidney donation is proscribed in Canada. Without an option of living-related transplantation (biological or emotional donors), patients often struggle with long waiting lists for deceased donor transplantation. Accordingly, many patients are now opting for more expedient avenues to obtaining a renal transplant. Through commercial organ retrieval programs, from living and deceased donors, patients are travelling outside Canada to have the procedure performed. METHODS Between September 2001 and July 2007, 10 patients (7 males, 3 females) underwent commercial renal transplantation outside Canada. We describe the clinical outcomes of these patients managed postoperatively at our single Canadian transplant centre. RESULTS Six living unrelated and 4 deceased donor renal transplantations were performed on these 10 patients (mean age 49.5 years). All procedures were performed in developing countries and the postoperative complications were subsequently treated at our centre. The mean post-transplant serum creatinine was 142 μmol/L. The average follow-up time was 29.8 months (range: 3 to 73 months). One patient required a transplant nephrectomy secondary to fungemia and subsequently died. One patient had a failed transplant and has currently resumed hemodialysis. Acute rejection was seen in 5 patients with 3 of these patients requiring re-initiation of hemodialysis. Only 1 patient had an uncomplicated course after surgery. DISCUSSION Despite the kidney trade being a milieu of corruption and commercialization, and the high risk of unconventional complications, patients returning to Canada after commercial renal transplantation are the new reality. Patients are often arriving without any documentation; therefore, timely, goal-directed therapy for surgical and infectious complications is frequently delayed because of the time taken to establish an accurate diagnosis. Refuting the existence of commercial renal transplantation may not be a practical solution; more consistent communication and documentation with transplant teams may be more pragmatic. In the current climate, patients considering the option of overseas commercial renal transplantation should be advised of the potential increased risks.
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Affiliation(s)
- Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
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Mazaris EM, Crane JS, Warrens AN, Smith G, Tekkis P, Papalois VE. Attitudes toward live donor kidney transplantation and its commercialization. Clin Transplant 2011; 25:E312-9. [DOI: 10.1111/j.1399-0012.2011.01418.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rizvi SAH, Naqvi SAA, Zafar MN, Mazhar F, Muzaffar R, Naqvi R, Akhtar F, Ahmed E. Commercial transplants in local Pakistanis from vended kidneys: a socio-economic and outcome study. Transpl Int 2009; 22:615-21. [PMID: 19207189 DOI: 10.1111/j.1432-2277.2009.00836.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Donor shortage and absence of transplant law lead to unrelated commercial transplants in Pakistan. We report the socio-economic and outcome parameters of 126 local recipients of unrelated kidney vendor transplants presenting to our institute between 1997 and 2007. Their outcome was compared with 180 recipients of living-related donor transplants matched for age, gender and transplant duration as controls. Age of commercial recipients was 35.63 +/- 11.57 years with an M:F ratio of 2.4:1. Majority (92%) were transplanted in northern Pakistan paying US$7271 +/- 2198. All were educated with 50% being graduates or above and rich earning a monthly salary of US$517 +/- 518 with 44% earning >US$500. Comparison of commercial recipients with controls showed high comorbidities 35 (28%) vs. 14 (8%) (P = 0.0001) with diabetes, hepatitis-C and cardiovascular diseases. Donor age was 29.97 +/- 6.16 vs. 32.63 +/- 9.3 years (P = 0.035). Biologic agents induction in 101 (80%) vs. 14 (8%) (P = 0.0001), acute rejections in 42 (33%) vs. 31 (17%) (P = 0.005), 1-year creatinine 1.84 +/- 1.28 vs. 1.27 +/- 0.4 mg/dl (P = 0.0001), surgical complications 28 (22%) vs. 14 (8%) (P = 0.001), tuberculosis 14 (11%) vs. 6 (6%) (P = 0.007), acute hepatitis 20 (16%) vs. 3 (2%) (P = 0.0001), cytomegalovirus 33 (26%) vs. 21 (11%) (P = 0.001) and recurrent urinary tract infection 35 (28%) vs. 30 (16%) (P = 0.034). Overall 1- and 5-year graft survival was 86% and 45% vs. 94% and 80%, respectively (P = 0.00001). Total deaths were 34 (27%) vs. 12 (6.0%) (P = 0.001). In conclusion, recipients of the vended kidneys are poor candidates, educated, rich and often self-selecting. Their outcome is poor, which will leave them poorer still and back to dialysis if not death.
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Shimazono Y. The state of the international organ trade: a provisional picture based on integration of available information. Bull World Health Organ 2008; 85:955-62. [PMID: 18278256 DOI: 10.2471/blt.06.039370] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 06/11/2007] [Indexed: 12/14/2022] Open
Abstract
Organ transplantation is widely practised worldwide. The expansion of organ transplantation has led to a critical shortage of organs and the development of the organ trade. Many patients travel to areas where organs are obtainable through commercial transactions. Although the international organ trade is regarded as an important health policy issue, its current state remains obscure because of scarce data and the lack of efforts to synthesize available data. This paper is an attempt to integrate information about the current international organ trade and create a tentative global picture based on a systematic review of 309 media reports, journal articles and other documents. The international organ trade is described in terms of its forms, the organ-exporting countries, the organ-importing countries and its outcomes and consequences.
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Affiliation(s)
- Yosuke Shimazono
- Institute of Social and Cultural Anthropology, University of Oxford, Oxford, England.
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Prasad GVR, Shukla A, Huang M, D'A Honey RJ, Zaltzman JS. Outcomes of commercial renal transplantation: a Canadian experience. Transplantation 2007; 82:1130-5. [PMID: 17102761 DOI: 10.1097/01.tp.0000241072.03400.11] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Financial compensation in exchange for live kidney donation is prohibited in Canada. However, patients in Canada with end-stage renal disease and without a suitable biologically or emotionally related live donor face substantial waiting times on lists for deceased donor kidneys, and so may therefore choose to acquire organs from a live donor in a procedure performed outside Canada as part of a commercial transaction. METHODS We describe the clinical outcomes in such patients transplanted between 1998 and 2005, managed after their surgery at a single Canadian transplant center. RESULTS Patient and graft survival at three years were significantly worse in this group compared to recipients of live biologically related (P<0.0001) and emotionally related transplants (P<0.01) performed in Canada during this period. A number of different surgical and infectious complications were seen, requiring frequent and often lengthy hospitalization. CONCLUSION Patients considering this method of acquiring live-donated kidneys should be counseled of the inherent risks and possible adverse outcomes including diminished dialysis-free survival.
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Affiliation(s)
- G V Ramesh Prasad
- Division of Nephrology, Department of Medicine, University of Toronto, Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
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Abstract
Although the waiting list for renal transplantation is growing from year to year, the participation of unrelated living donors in kidney transplantation remains controversial. Patients want to be transplanted as soon as possible, not years later. Nevertheless, cadaveric organ donation has not been able to meet the requirements for all patients in need. With a continuous shortage of organs, the use of living unrelated donors is likely to decrease patient suffering and waiting list mortality. The excellent short- and long-term results of living unrelated transplantation have stimulated physicians toward a wider use of this donor pool. Therefore, transplants from living donors, whether related or unrelated, may be proposed as a therapeutic option for end-stage renal disease patients. In this article we explain the necessity of compensating altruistic living donors as an incentive. It is concluded that living unrelated renal transplantation programs should be legalized and controlled by international and national transplant societies to prevent illegal trade and to provide better care for donors.
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Affiliation(s)
- B Larijani
- Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Friedman EA. Ethical stresses in uremia therapy: the worst is yet to come. ASAIO J 2002; 48:209-10. [PMID: 12058990 DOI: 10.1097/00002480-200205000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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