1
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Merhav H. Transplant tourism - a missed opportunity. Curr Opin Organ Transplant 2023; 28:457-462. [PMID: 37791523 DOI: 10.1097/mot.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW To explore the resurgence of transplant tourism (TT) despite the recent reiteration of the Declaration of Istanbul (DoI) in 2018. As demand grows exponentially and supply remains static, novel approaches to bridging the gap should be explored. RECENT FINDINGS TT is estimated to comprise up to 10% of transplants worldwide. Prosecuting patients seeking organs through TT has been unsuccessful. Extra jurisdictional prosecution of brokers, vendors and institutions participating in illicit TT has been difficult. Resurgence of TT has occurred in both "traditional" and new countries. The public attitude towards TT and paid donation is largely positive. The Iranian experience with state regulated paid donors merits attention and perhaps emulation. Numerous philosophers, ethicists and transplant professionals find it acceptable to promote financial consideration for organ donors. SUMMARY Acknowledging the autonomy of persons, including poor and vulnerable ones, to receive financial consideration for their sacrifice should not be considered morally reprehensible. Strict international regulation, oversight and legislation should be implemented to assure adequate compensation, donor wellbeing, elimination of brokers and excellent medical care. Implementing such a system internationally may eliminate kidney waiting lists, provide great benefits to vendors, improve transplant facilities in developing countries and provide substantial savings to insurers.
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Affiliation(s)
- Hadar Merhav
- Transplantation Unit, Soroka Medical Center, Ben Gurion University Medical School, Beer Sheba, Israel
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2
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Gardiner D, McGee A, Simpson C, Ahn C, Goldberg A, Kinsella A, Nagral S, Weiss MJ. Baseline Ethical Principles and a Framework for Evaluation of Policies: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1471. [PMID: 37138553 PMCID: PMC10150897 DOI: 10.1097/txd.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/26/2022] [Accepted: 12/15/2022] [Indexed: 05/05/2023] Open
Abstract
To maintain public trust and integrity in organ and tissue donation and transplantation (OTDT), policymakers, governments, clinical leaders, and decision-makers must ensure that policies proposed to increase donation and transplant activity satisfy baseline ethical principles established by international agreement, declaration, and resolution. This article describes the output of the Baseline Ethical Domain group of an international forum designed to guide stakeholders in considering these aspects of their system. Methods This Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. The domain working group members included administrative, clinical, and academic experts in deceased and living donation ethics and 2 Patient, Family, and Donor partners. Identification of internationally accepted baseline ethical principles was done after literature reviews performed by working group members, and a framework for consideration of existing or novel policies was completed over a series of virtual meetings from March to September 2021. Consensus on the framework was achieved by applying the nominal group technique. Recommendations We used the 30 baseline ethical principles described in World Health Organization Guiding Principles, Declaration of Istanbul, and Barcelona Principles to generate an ethical framework-presented graphically as a spiral series of considerations-designed to assist decision makers in incorporating these ethical principles into practice and policy. We did not seek to determine what is ethical but instead described a method of evaluation for policy decisions. Conclusions The proposed framework could be applied to new or existing OTDT policy decisions to facilitate the transformation of widely accepted ethical principles into practical evaluations. The framework includes adaptation for local contexts and could be applied broadly internationally.
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Affiliation(s)
- Dale Gardiner
- Medical Directorate, NHS Blood and Transplant, Nottingham, United Kingdom
| | - Andrew McGee
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Faculty of Business and Law, QUT, Brisbane, Australia
| | - Christy Simpson
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Department of Bioethics, Dalhousie University, Halifax, Canada
- Canadian Blood Services, Ottawa, Canada
| | - Curie Ahn
- Division of Nephrology, National Medical Center, Seoul, South Korea
| | - Aviva Goldberg
- Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada
| | - Austin Kinsella
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
- Co-chair: Declaration of Istanbul Custodian Group
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Transplant Québec, Montréal, Québec, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, Québec, Canada
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3
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Bonkano D, Tondi ZMM, Diongolé HM, Illiassou A, Abdou I, Isaac ODM, Mohamadou BR, Massi AWI, Omar AE, Rostaing L. Status Report of Renal Transplant Patients in Niger. Transplant Proc 2023; 55:332-336. [PMID: 36822882 DOI: 10.1016/j.transproceed.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/08/2023] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Kidney transplantation is the treatment of choice for end-stage chronic kidney disease. It improves quality of life and increases life expectancy. At present, Niger is one of the poorest countries in the world does not practice kidney transplantation; thus, patients continue to be referred to other countries for transplantation. METHODS This descriptive cross-sectional study was carried out at the Nephrology Department of the National Hospital Amirou Boubacar Diallo in Niamey, Niger over a 5-month period. It included all patients that had benefited from kidney transplantation with the aim to evaluate patient and graft survival. RESULTS We identified 25 patients. The male to female ratio was 2:1. The average age was 45.4 years ± 11.1 years. The average age of donors was 36.1 years ± 12.6 years with a clear male predominance (17 males to 8 females); all of them were related-donors with 72% of them being brothers or sisters. The causative nephropathy was undetermined in 80% of patients. Sixty-four percent of patients had their kidney transplant in Maghreb, including 16% in Tunisia. The complications were mostly medical (68%), as 20% were immunologic; 8% infectious; 16% metabolic; 20% cardiovascular, and 4% were related to recurrence of the initial nephropathy. Surgical complications involved 6 patients (24%): 5 were vascular cases and one was a urological case. With a median follow-up of 5 years, the patients' survival was 84%, the graft survival was 56%, and death-censored graft survival was 67%. CONCLUSION In Niger, after kidney transplantation, the patients' survival is satisfactory, whereas the graft survival is not, mostly due to inadequate follow-up check-ups and prohibitive prices of immunosuppressants.
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Affiliation(s)
| | - Zeinabou Maiga Moussa Tondi
- Amirou Boubacar Diallo National Hospital in Niamey, Niger; Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger
| | | | | | - Ide Abdou
- Amirou Boubacar Diallo National Hospital in Niamey, Niger
| | | | | | | | - Adehossi Eric Omar
- Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger; Niamey General Referral Hospital, Niger
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation department, University Teaching, Hospital Grenoble-Alpes, Grenoble, France; University Grenoble Alpes, Grenoble, France.
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4
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Gill J, Clark S, Gill G, Gill J, Richardson C. A Survey Study to Examine Willingness to Travel for Transplantation and Consider Commercial Transplantation Among a Multi-Ethnic Cohort of Canadians. Kidney Int Rep 2023; 8:898-906. [PMID: 37069985 PMCID: PMC10105248 DOI: 10.1016/j.ekir.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/10/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Travel for transplantation is the movement of organs, donors, recipients, or transplant professionals across jurisdictional borders for transplantation purposes and is considered transplant tourism if transplant commercialism is involved. Little is known about the willingness of patients at risk for transplant tourism to engage in this practice. Methods A cross-sectional survey of patients with end-stage renal disease was conducted in Canada to determine interest in travel for transplantation and transplant tourism, characterize patients according to their willingness to consider transplant tourism, and identify factors to deter willingness to consider transplant tourism. Surveys were conducted face-to-face and in multiple languages. Results Among the 708 patients surveyed, 418 (59%) reported a willingness to travel outside of Canada for transplantation, with 24% reporting a strong willingness. One hundred sixty-one (23%) reported a willingness to travel and purchase a kidney overseas. On multivariate analysis, male sex, younger age, and Pacific Islander ethnicity were associated with higher odds of willingness to travel for transplant, whereas male sex, annual income greater than $100,000, and Asian and Middle Eastern ethnicity were associated with higher odds of willing to travel to purchase a kidney. Willingness reduced when respondents were informed of medical risks and legal implications related to travel for transplantation. Financial and ethical considerations were less effective at reducing willingness to travel for transplantation. Conclusion There was a high level of interest in travel for transplantation and transplant tourism. Legal consequences and education on medical risks of transplant tourism may be effective deterrent strategies.
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Affiliation(s)
- Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences University of British Columbia, Vancouver, Canada
- Correspondence: Jagbir Gill, Division of Nephrology University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z1Y6, Canada.
| | - Stephanie Clark
- Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Gurleen Gill
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences University of British Columbia, Vancouver, Canada
| | - Chris Richardson
- Centre for Health Evaluation and Outcomes Sciences University of British Columbia, Vancouver, Canada
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Altheaby A, Owaidah K, Alotaibi A, Salem R, Algain R, Alotaibi A, Alnasrullah A, Shaheen MF, Tawhari M, Abdulgadir M. Graft and Patient Outcomes of Kidney Transplant Tourism: A Single-Center Experience. Avicenna J Med 2022; 12:120-126. [PMID: 36092382 PMCID: PMC9458345 DOI: 10.1055/s-0042-1750715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background
The supply-demand mismatch between organ donor and patient waiting for transplant has led to the growth of transplant tourism. This type of transplant is considered unethical and illegal, as it is usually performed in poor environments and carries a higher risk of infectious, vascular, and immunological complications.
Methods
In this single-centered retrospective cohort study, we compared patients who underwent transplant tourism to patients who were transplanted locally and followed up in our hospital from January 2015 to December 2018.
Result
A total of 254 local transplants and 60 patients from the transplant tourism group were included. Transplant tourism recipients were younger otherwise both groups were similar in gender, body mass index, diabetes, and hypertension. Recipients in the transplant tourism group had a significantly higher rate of delayed graft function (18.3% vs. 6.3%,
p
0.005), acute rejection (40% vs. 7.9%,
p
< 0.001), and higher posttransplant infection in general. With more urological complications and higher graft failure at 3-years' follow-up (11.7% vs. 0.8%,
p
< 0.001).
Conclusion
Transplant tourism is associated with a higher risk of infection and poor graft outcomes. Extra efforts are required to cut down transplant tourism by educating patients about its clinical risk and ethical considerations. In addition, measures to increase the number of deceased donor pool to provide a better alternative options for patients are essential.
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Affiliation(s)
- Abdulrahman Altheaby
- Department of Organ Transplant Center and Hepatobiliary Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Kenana Owaidah
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Aljowharah Alotaibi
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Rahaf Salem
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Rihaf Algain
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Areij Alotaibi
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmad Alnasrullah
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed F. Shaheen
- Department of Organ Transplant Center and Hepatobiliary Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed Tawhari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohamad Abdulgadir
- Department of Organ Transplant Center and Hepatobiliary Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Prasad GVR, Sahay M, Kit-Chung Ng J. The Role of Registries in Kidney Transplantation Across International Boundaries. Semin Nephrol 2022; 42:151267. [PMID: 36577647 DOI: 10.1016/j.semnephrol.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transplant professionals strive to improve domestic kidney transplantation rates safely, cost efficiently, and ethically, but to increase rates further may wish to allow their recipients and donors to traverse international boundaries. Travel for transplantation presents significant challenges to the practice of transplantation medicine and donor medicine, but can be enhanced if sustainable international registries develop to include low- and low-middle income countries. Robust data collection and sharing across registries, linking pretransplant information to post-transplant information, linking donor to recipient information, increasing living donor transplant activity through paired exchange, and ongoing reporting of results to permit flexibility and adaptability to changing clinical environments, will all serve to enhance kidney transplantation across international boundaries.
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Affiliation(s)
- G V Ramesh Prasad
- Kidney Transplant Program, St. Michael Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Osmania Medical College, Hyderabad, Telangana, India
| | - Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Center, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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7
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Dharia AA, Huang M, Nash MM, Dacouris N, Zaltzman JS, Prasad GVR. Post-transplant outcomes in recipients of living donor kidneys and intended recipients of living donor kidneys. BMC Nephrol 2022; 23:97. [PMID: 35247959 PMCID: PMC8898413 DOI: 10.1186/s12882-022-02718-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Long-term kidney transplant survival at the population level is consistently favorable, but this survival varies widely at an individual level due to both recipient and donor factors. The distinct contribution of recipient and donor factors to individual post kidney transplant outcome remains unclear. Comparing outcomes in deceased donor (DD) recipients with potential but non-actualized living donors (DD1) to those recipients with actualized living donors (LD), and to DD recipients without potential living donors (DD0) may provide transplant candidates with more information about their own post-transplant prognosis. Methods We conducted an observational retrospective cohort study of kidney transplant candidates presenting to our centre for evaluation between 01/01/06 and 31/12/18, and who also received a transplant during that time. Patients were followed to 31/08/2019. Candidates were classified as DD0, DD1, or LD based on whether they had an identified living donor at the time of initial pre-transplant assessment, and if the donor actualized or not. Primary outcome was 5-year death-censored graft survival, adjusted for common pre- and post-transplant donor and recipient risk factors. Secondary outcomes analyzed included patient survival and graft function. Results There were 453 kidney transplant recipients (LD = 136, DD1 = 83, DD0 = 234) who received a transplant during the study period. DD0 and DD1 did not differ in key donor organ characteristics. The 5-year death censored graft survival of DD1 was similar to LD (p = 0.19). DD0 graft survival was inferior to LD (p = 0.005), but also trended inferior to DD1 (p = 0.052). By multivariate Cox regression analysis, LD demonstrated similar 5-year graft survival to DD1 (HR for graft loss 0.8 [95% CI 0.25–2.6], p = 0.72) but LD graft survival was superior to DD0 (HR 0.34 [0.16–0.72], p = 0.005). The 5-year patient survival in DD1 was similar to LD (p = 0.26) but was superior to DD0 (p = 0.01). Conclusions DD recipients with potential but non-actualized living donors exhibit similar mid-term graft and patient survival compared to LD recipients. Having an identified living donor at the time of pre-transplant assessment portends a favorable prognosis for the recipient. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02718-6.
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8
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Abstract
BACKGROUND Medical tourism has been increasing dramatically globally, with people travelling from developed countries to low-income or middle-income countries, often to avoid high costs or long delays associated with seeking healthcare in their countries of origin. The current review summarizes healthcare-related infections associated with medical tourism, focusing on cosmetic surgery and organ transplantation. METHODS A systematic MEDLINE and PubMed search from January 2010 to December 2019 yielded 80 relevant articles, including 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation, which were included in this reviews. RESULTS The literature reveals specific types of cross-border, healthcare-related infections depending on medical intervention. Destinations include low-income countries such as countries of Asia and the Indian subcontinent, middle-income countries including Central and South America, and high-income countries such as the United States and Europe. In terms of type of infections, in 36 (68%) and 15 (28.3%) studies, wound and blood-borne infections were documented, respectively, while in 21 studies (58.3%) non-tuberculous mycobacteria were isolated, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalense and Mycobacterium fortuitum. The choices of medical tourists could have significant consequences for them and their home countries, including infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications. CONCLUSIONS There is a need for public health strategies in order to prevent morbidity and mortality as well as future management and education of patients engaging in medical tourism.
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Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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9
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Affiliation(s)
- Feras Bader
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Yosef Manla
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | | | - And Nizar Attallah
- Medical Subspecialty Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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10
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Martin DE, Harris DCH, Jha V, Segantini L, Demme RA, Le TH, McCann L, Sands JM, Vong G, Wolpe PR, Fontana M, London GM, Vanderhaegen B, Vanholder R. Ethical challenges in nephrology: a call for action. Nat Rev Nephrol 2020; 16:603-613. [PMID: 32587403 DOI: 10.1038/s41581-020-0295-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
The American Society of Nephrology, the European Renal Association-European Dialysis and Transplant Association and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology have identified ten broad areas of ethical concern as priority challenges that require collaborative action. Here, we describe these challenges - equity in access to kidney failure care, avoiding futile dialysis, reducing dialysis costs, shared decision-making in kidney failure care, living donor risk evaluation and decision-making, priority setting in kidney disease prevention and care, the ethical implications of genetic kidney diseases, responsible advocacy for kidney health and management of conflicts of interest - with the aim of highlighting the need for ethical analysis of specific issues, as well as for the development of tools and training to support clinicians who treat patients with kidney disease in practising ethically and contributing to ethical policy-making.
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Affiliation(s)
- Dominique E Martin
- School of Medicine, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, Australia.
| | - David C H Harris
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- University of Oxford, Oxford, UK
- Manipal Academy of Higher Education, Manipal, India
| | - Luca Segantini
- International Society of Nephrology, Brussels, Belgium
- European Society for Organ Transplantation - ESOT c/o ESOT, Padova, Italy
| | - Richard A Demme
- Renal Division and Department of Medical Humanities and Bioethics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Thu H Le
- Nephrology Division, Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Laura McCann
- American Society of Nephrology, Washington, DC, USA
| | - Jeff M Sands
- Renal Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Gerard Vong
- Center for Ethics, Emory University, Atlanta, GA, USA
| | | | - Monica Fontana
- European Renal Association - European Dialysis and Transplant Association, Parma, Italy
| | - Gerard M London
- Manhes Hospital, Nephrology Department GEPIR, Fleury-Mérogis, France
| | | | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital, Corneel Heymanslaan 10, B9000, Gent, Belgium
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11
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Abstract
PURPOSE OF REVIEW To outline the impact of transplant tourism on the type and severity of post-transplant infections that may be seem in returning transplant tourists. This review outlines infections that might be expected and provides recommendations on screening tests that may assist in the diagnosis and management of such patients. RECENT FINDINGS Transplant tourists may develop unusual or resistant infections that pose a public health risk in their home country. The practice of transplant tourism is associated with a significantly increased risk of surgical and infectious complications after transplant. Returning transplant tourists require a thorough evaluation for active and latent infections. Transplant centers must be vigilant for new and emerging pathogens in this population.
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Affiliation(s)
- Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th St., Suite 842 (R-21), Miami, FL, 33136, USA.
| | - Elmi Muller
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa
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12
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Stewart J, Newman GS, Jain R, Bryan A, Berger H, Montenovo M, Bakthavatsalam R, Kling CE, Sibulesky L, Shalhub S, Limaye AP, Fisher CE, Rakita RM. Transplant tourism complicated by life-threatening New Delhi metallo-β-lactamase-1 infection. Am J Transplant 2019; 19:1224-1228. [PMID: 30282120 PMCID: PMC6436391 DOI: 10.1111/ajt.15136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/02/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
Abstract
Transplant tourism, which is the practice of traveling to other countries for transplant, continues to be a major problem worldwide. We describe a patient who traveled to Pakistan and underwent commercial kidney transplant. He developed life-threatening infections from New Delhi metallo-β-lactamase-1-producing Enterobacter cloacae and Rhizopus oryzae, resulting in a necrotizing kidney allograft infection and subsequent external iliac artery rupture. He survived after a prolonged course of nonstandardized antimicrobial therapy, including a combination of aztreonam and ceftazidime-avibactam, and aggressive surgical debridement with allograft nephrectomy. The early timing of infection with these unusual organisms localized to the allograft suggests contamination and substandard care at the time of transplant. This case highlights the challenges of caring for these infections and serves as a cautionary tale for the potential complications of commercial transplant tourism.
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Affiliation(s)
- Jenell Stewart
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Gretchen Snoeyenbos Newman
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Rupali Jain
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.,Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Andrew Bryan
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Heather Berger
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Martin Montenovo
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Ramasamy Bakthavatsalam
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Catherine E. Kling
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Lena Sibulesky
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Sherene Shalhub
- Department of Surgery, Division of Vascular Surgery, University of Washington, Seattle, Washington, USA
| | - Ajit P. Limaye
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Cynthia E. Fisher
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Robert M. Rakita
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
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13
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AlBugami MM, AlOtaibe FE, Alabadi AM, Hamawi K, Bel'eed-Akkari K. Transplant tourism following the declaration of Istanbul: Poor outcomes and nephrologist dilemma. Nephrology (Carlton) 2018; 23:1139-1144. [DOI: 10.1111/nep.13181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Meteb M AlBugami
- Multi-Organ Transplant Center; King Fahad Specialist Hospital; Dammam Saudi Arabia
- Department of Internal Medicine, College of Medicine; University of Dammam; Dammam Saudi Arabia
| | - Fahad E AlOtaibe
- Multi-Organ Transplant Center; King Fahad Specialist Hospital; Dammam Saudi Arabia
- Department of Internal Medicine, College of Medicine; University of Dammam; Dammam Saudi Arabia
| | - Abdulnaser M Alabadi
- Multi-Organ Transplant Center; King Fahad Specialist Hospital; Dammam Saudi Arabia
| | - Khaled Hamawi
- Multi-Organ Transplant Center; King Fahad Specialist Hospital; Dammam Saudi Arabia
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Domínguez-Gil B, Danovitch G, Martin DE, López-Fraga M, Van Assche K, Morris ML, Lavee J, Erlich G, Fadhil R, Busic M, Rankin G, Al-Rukhaimi M, OʼConnell P, Chin J, Norman T, Massari P, Kamel R, Delmonico FL; Declaration of Istanbul Custodian Group working group on ethical travel for transplantation. Management of Patients Who Receive an Organ Transplant Abroad and Return Home for Follow-up Care: Recommendations From the Declaration of Istanbul Custodian Group. Transplantation 2018; 102:e2-9. [PMID: 29019810 DOI: 10.1097/TP.0000000000001963] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Eradicating transplant tourism depends on complex solutions that include efforts to progress towards self-sufficiency in transplantation. Meanwhile, professionals and authorities are faced with medical, legal, and ethical problems raised by patients who return home after receiving an organ transplant abroad, particularly when the organ has been obtained through illegitimate means. In 2016, the Declaration of Istanbul Custodian Group convened an international, multidisciplinary workshop in Madrid, Spain, to address these challenges and provide recommendations for the management of these patients, which are presented in this paper. The core recommendations are grounded in the belief that principles of transparency, traceability, and continuity of care applied to patients who receive an organ domestically should also apply to patients who receive an organ abroad. Governments and professionals are urged to ensure that, upon return, patients are promptly referred to a transplant center for evaluation and care, not cover the costs of transplants resulting from organ or human trafficking, register standardized information at official registries on patients who travel for transplantation, promote international exchange of data for traceability, and develop a framework for the notification of identified or suspected cases of transnational transplant-related crimes by health professionals to law enforcement agencies.
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Bonnet M, Hiesse C, Sberro-soussan R, Glotz D, Durrbach A, Randoux C, Tourret J, Rondeau E, Le Quintrec M. Évolution du tourisme de transplantation rénale en France, complications et survie des greffons. Nephrol Ther 2018; 14:423-424. [DOI: 10.1016/j.nephro.2018.07.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tapak L, Hamidi O, Amini P, Poorolajal J. Prediction of Kidney Graft Rejection Using Artificial Neural Network. Healthc Inform Res 2017; 23:277-284. [PMID: 29181237 PMCID: PMC5688027 DOI: 10.4258/hir.2017.23.4.277] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/17/2017] [Accepted: 09/10/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Kidney transplantation is the best renal replacement therapy for patients with end-stage renal disease. Several studies have attempted to identify predisposing factors of graft rejection; however, the results have been inconsistent. We aimed to identify prognostic factors associated with kidney transplant rejection using the artificial neural network (ANN) approach and to compare the results with those obtained by logistic regression (LR). METHODS The study used information regarding 378 patients who had undergone kidney transplantation from a retrospective study conducted in Hamadan, Western Iran, from 1994 to 2011. ANN was used to identify potential important risk factors for chronic nonreversible graft rejection. RESULTS Recipients' age, creatinine level, cold ischemic time, and hemoglobin level at discharge were identified as the most important prognostic factors by ANN. The ANN model showed higher total accuracy (0.75 vs. 0.55 for LR), and the area under the ROC curve (0.88 vs. 0.75 for LR) was better than that obtained with LR. CONCLUSIONS The results of this study indicate that the ANN model outperformed LR in the prediction of kidney transplantation failure. Therefore, this approach is a promising classifier for predicting graft failure to improve patients' survival and quality of life, and it should be further investigated for the prediction of other clinical outcomes.
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Affiliation(s)
- Leili Tapak
- Modeling of Noncommunicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Omid Hamidi
- Department of Science, Hamedan University of Technology, Hamedan, Iran
| | - Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Jalal Poorolajal
- Research Center for Health Sciences & Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, Faculty of Law (Caulfield), University of Alberta, Edmonton, Alta.; Johnson Shoyama Graduate School of Public Policy (Zarzeczny), University of Regina, Regina, Sask.
| | - Amy Zarzeczny
- Health Law Institute, Faculty of Law (Caulfield), University of Alberta, Edmonton, Alta.; Johnson Shoyama Graduate School of Public Policy (Zarzeczny), University of Regina, Regina, Sask
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18
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Chapman JR, Delmonico FL. Buyer beware transplantation. Kidney Int 2016; 89:983-985. [PMID: 27083275 DOI: 10.1016/j.kint.2016.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/28/2016] [Indexed: 10/21/2022]
Abstract
Poor long-term outcomes of commercial transplantation of transplant tourists reinforce the need to prevent this form of human trafficking. The development of an International Convention by the Council of Europe is highlighted and the implications for physicians of the criminalizing of organ trafficking are considered. The causes of poor outcomes from transplant tourism are considered, with the actions needed to provide both equity and sufficiency of access to transplantation as critical deterrent measures.
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Affiliation(s)
- Jeremy R Chapman
- Department of Medicine and Cancer, Westmead Hospital, Sydney, New South Wales, Australia.
| | - Francis L Delmonico
- Department of Surgery, Harvard Medical School at the Massachusetts General Hospital, Boston, Massachusetts, USA
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