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Albertsen A. Efficiency and the futures market in organs. Monash Bioeth Rev 2023; 41:66-81. [PMID: 37688713 DOI: 10.1007/s40592-023-00180-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/11/2023]
Abstract
There has been considerable debate over regulated organ markets. Especially current markets, where people sell one of their kidneys while still alive, have received increased attention. Futures markets remain an interesting and under-discussed alternative specification of a market-based solution to the organ shortage. Futures markets pertain to the sale of the right to procure people's organs after they die. There is a wide range of possible specifications of the futures market. There are, however, some major unaddressed efficiency concerns. This article presents this class of concerns and discusses the implication for organ futures markets. It identifies a number of inefficiency sources pertaining to crowding out, bad organs, costs and missed opportunities, family refusals, moral hazard and strength of the provided incentive. However, a complete assessment of futures market requires better knowledge regarding the potential reaction from donors, families and health professionals.
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Affiliation(s)
- Andreas Albertsen
- Department of Political Science and the Centre for the Experimental-Philosophical Study of Discrimination CEPDISC, Aarhus University, Bartholins Alle 7, 8000, Aarhus, Denmark.
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Sever MS, Van Biesen W, Vanholder R, Mallick N, London G, Schena FP, Nagy J, Buturovic-Ponikvar J, Heering P, Maggiore U, Mariat C, Watschinger B, Oniscu G, Peruzzi L, Gandolfini I, Hellemans R, Abramowicz D, Pascual J, Hilbrands L. Ethical and medical dilemmas in paid living kidney donor transplantation. Transplant Rev (Orlando) 2022; 36:100726. [PMID: 36113305 DOI: 10.1016/j.trre.2022.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022]
Abstract
Due to the shortage of deceased and genetically- or emotionally-related living donors, living unrelated paid donor (LURpD) kidney transplantation has been considered; however, this practice may result in medical, ethical and social dilemmas, induce organ trading (commodification), and even criminal activities. Commodification also risks undermining public trust in the transplant system and impeding the development of proper altruistic or deceased donor programs by ignoring altruism, volunteerism, and dignity. However, despite many objections by authoritative organizations, black market practices are involved in up to 10% of all transplants worldwide. The authors strongly discourage any payment or rewards for organ donation, and instead urge the governments of all countries to provide adequate and accessible kidney health care. However, it is an undeniable fact that paid-living donor transplantation is increasing despite all objections, disapprovals and regulations. We feel it as our responsibility not to ignore this uncertain and undesirable practice, but rather to underline the necessity for strict rules and prohibitions to minimize unacceptable medical, social and ethical risks as long as it exists. Furthermore, economic profit, be it direct or indirect, must not be the goal of those involved, and the employment of intermediaries must be avoided entirely. Additionally, the donor should be in a position where not donating has no detrimental effect on his/her future in any way (free agency). In our view, every country has the obligation and responsibility to provide adaequate kidney health care and to make kidney transplantation accessible to those in need. This provision is key to stop transplant tourism and commercialization of kidney transplantation. The nephrology community has a duty to establish structures that optimize organ availability within strict ethical limits. The legal position of LURpD varies considerably worldwide. Strictly respecting each country's legislation and local values is mandatory to minimize medical and ethical risks and controversies.
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Ahn C, Lee S, Kim YH, Oh J, Yun IJ, Ahn HJ, Seo SH, Jeong JC, Kim MS, Ha J, Kim SI, Moon IS, Cho WH. Improving self-sufficiency in organ transplantation in Korea. Korean J Transplant 2021; 35:137-142. [PMID: 35769245 PMCID: PMC9235443 DOI: 10.4285/kjt.21.0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/10/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022] Open
Abstract
After attaining a qualified medical capacity in organ transplantation, Korea has been struggling to increase the number of deceased organ transplants to reach self-sufficiency. As one of these efforts, Korea revised the organ transplantation law in 2010 by adding three articles the mandatory reporting based on the recommendation of the 3rd Global Consultation on Organ Transplantation of Madrid in 2010. Along with the new constitution, considerable efforts have been initiated to upgrade the deceased organ transplantation system while maintaining the virtues of fairness, justice, and transparency. The Korean Society of Transplantation played a critical role in revising the law as well as in establishing organizations such as the Korean Organ Donation Agency (KODA; 2009), the Vitallink (2009), and the Korean Organ Transplantation Registry (KOTRY; 2010). By the activities of these professional organizations, Korea could implement fundamental programs such as mandatory reporting and could develop various education programs for organ donation for students and the general population. As a result, the number of deceased donors increased from 1.08 p.m.p. (2000) to 9.23 p.m.p.(2020). Further efforts are needed to increase the number of organ donor cardholders and family consent rates by well-designed, target-specific education programs to overcome traditional negative cultural barriers toward organ donation. The community atmosphere of honoring and thanking donors and their families should be nurtured by national and regional activities of life-sharing weeks linked with organ donor memorial parks.
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Affiliation(s)
- Curie Ahn
- Division of Nephrology, National Medical Center, Seoul, Korea
- Vitallink, Seoul, Korea
| | - Samuel Lee
- Department of Surgery, KangNam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yeong Hoon Kim
- Division of Nephrology, Inje University Busan Paik Hospital, Busan, Korea
| | - Jieun Oh
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ik Jin Yun
- Department of Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Hyung Joon Ahn
- Department of Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | | | - Jong Cheol Jeong
- Division of Nephrology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | | | - Won Hyun Cho
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
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Neupane R, Taweesedt PT, Anjum H, Surani S. Current state of medical tourism involving liver transplantation-the risk of infections and potential complications. World J Hepatol 2021; 13:717-722. [PMID: 34367493 PMCID: PMC8326159 DOI: 10.4254/wjh.v13.i7.717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/29/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
Liver transplant has been shown to significantly improve mortality and quality of life in various liver diseases such as acute liver failure, end-stage liver disease, and liver cancer. While the organ transplant demand is continuing to rise, the organ donation supply remains unmatched. The organ shortage, high cost, and long waiting lists have stimulated a desire for routes that may be unethical. This process which is named transplant tourism is the term used to describe traveling to another country to purchase an organ for transplant. Liver transplant tourism has been associated with post-transplant complications and higher mortality compared to a domestic liver transplant. Improper pre-and post-transplant infectious screening, inadequate opportunistic infection prophylaxis, and loss to follow-up were noted in patients who travel abroad for a liver transplant. It is crucial to understand the risk of transplant tourism to prevent morbidity and mortality.
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Affiliation(s)
- Ritesh Neupane
- Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA 17033, United States
| | - Pahnwat Tonya Taweesedt
- Department of Medicine, Corpus Christi Medical Center, Corpus Christi, TX 78412, United States
| | - Humayun Anjum
- Department of Medicine, University of North Texas, Corpus Christi, TX 78412, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University, College Station, TX 77843, United States
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Torres Soto M, Kotton CN. Infectious disease complications of transplant tourism. Expert Rev Anti Infect Ther 2021; 19:671-673. [PMID: 33186078 DOI: 10.1080/14787210.2020.1851196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mariam Torres Soto
- Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Camille Nelson Kotton
- Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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Lentine KL, Motter JD, Henderson ML, Hays RE, Shukhman E, Hunt J, Al Ammary F, Kumar V, LaPointe Rudow D, Van Pilsum Rasmussen SE, Nishio-Lucar AG, Schaefer HM, Cooper M, Mandelbrot DA. Care of international living kidney donor candidates in the United States: A survey of contemporary experience, practice, and challenges. Clin Transplant 2020; 34:e14064. [PMID: 32808320 DOI: 10.1111/ctr.14064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 12/25/2022]
Abstract
The evaluation and care of non-US citizen, non-US residents who wish to come to the United States to serve as international living kidney donors (ILKDs) can pose unique challenges. We surveyed US transplant programs to better understand practices related to ILKD care. We distributed the survey by email and professional society list-servs (Fall 2018, assessing 2017 experience). Eighty-five programs responded (36.8% program response rate), of which 80 considered ILKD candidates. Only 18 programs had written protocols for ILKD evaluation. Programs had a median of 3 (range: 0,75) ILKD candidates who initiated contact during the year, from origin countries spanning 6 continents. Fewer (median: 1, range: 0,25) were approved for donation. Program-reported reasons for not completing ILKD evaluations included visa barriers (58.6%), inability to complete evaluation (34.3%), concerns regarding follow-up (31.4%) or other healthcare access (28.6%), and financial impacts (21.4%). Programs that did not evaluate ILKDs reported similar concerns. Staff time required to evaluate ILKDs was estimated as 1.5-to-3-times (47.9%) or >3-times (32.9%) that needed for domestic candidates. Among programs accepting ILKDs, on average 55% reported successful completion of 1-year follow-up. ILKD evaluation is a resource-intensive process with variable outcomes. Planning and commitment are necessary to care for this unique candidate group.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri, USA
| | - Jennifer D Motter
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Macey L Henderson
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Rebecca E Hays
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Ellen Shukhman
- Cedars-Sinai Comprehensive Transplant Center, Los Angeles, California, USA
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, USA
| | - Fawaz Al Ammary
- Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Center, Birmingham, Alabama, USA
| | | | | | | | | | - Matthew Cooper
- MedStar Georgetown Transplant Institute, Washington, District of Columbia, USA
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Shukhman E, Hunt J, LaPointe-Rudow D, Mandelbrot D, Hays R, Kumar V, Schaefer H, Ammary FA, Henderson ML, Nishio-Lucar A, Cooper M, Lentine KL. Evaluation and care of international living kidney donor candidates: Strategies for addressing common considerations and challenges. Clin Transplant 2020; 34:e13792. [PMID: 31991481 PMCID: PMC8761064 DOI: 10.1111/ctr.13792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/28/2019] [Accepted: 01/19/2020] [Indexed: 12/24/2022]
Abstract
End-stage kidney disease patients in the United States may have family members or friends who are not US citizens or residents but are willing to serve as their living kidney donor in the United States ("international donors"). In July 2017, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) convened a multidisciplinary workgroup of experts in living donation care, including coordinators, social workers, donor advocates, administrators, and physicians, to evaluate educational gaps related to the evaluation and care of international donors. The evaluation of international living donor candidates is a resource-intensive process that raises key considerations for assessing risk of exploitation/inducement and addressing communication barriers, logistics barriers, and access to care in their home country. Through consensus-building discussions, we developed recommendations related to: (a) establishing program guidelines for international donor candidate evaluation and selection; (b) initial screening; (c) logistics planning; (d) comprehensive evaluation; and (e) postdonation care and follow-up. These recommendations are not intended to direct formal policy, but rather as guidance to help programs more efficiently and effectively structure and execute evaluations and care coordination. We also offer recommendations for research and advocacy to optimize the care of this unique group of living donors.
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Affiliation(s)
- Ellen Shukhman
- Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| | | | | | - Rebecca Hays
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Center, Birmingham, AL
| | | | - Fawaz Al Ammary
- Johns Hopkins Comprehensive Transplant Center, Baltimore, MD
| | | | | | | | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
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Abstract
Liver transplant tourism is travel for transplantation involving organ trafficking and/or transplant commercialism. Various medical, financial, and organizational factors play a role in transplant care including waiting lists, Model for End-Stage Liver Disease scores, and financial aid. We outline the international experiences with transplant tourism (TT) and its effect on their medical communities and patients. For clinicians providing care to patients involved in TT, we also discuss pretransplant counseling and posttransplant care.
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Affiliation(s)
- Zaid Hindi
- Department of Medicine, Division of Gastroenterology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Stephen Congly
- Department of Medicine, Division of Gastroenterology, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Ephraim Tang
- Department of Surgery, Division of General Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Anton Skaro
- Department of Surgery, Division of General Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mayur Brahmania
- Department of Medicine, Division of Gastroenterology, London Health Sciences Centre, Western University, London, Ontario, Canada
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Islam MM, Webb B, Palais R, Kuddus RH. Assessing the Potential Impact of the Declaration of Istanbul 2008 on Internet Reporting of Human Organ Transplantation-Related Crimes Using Interrupted Time Series Analysis and Meta-Analysis Approaches. Transplant Proc 2020; 52:12-19. [DOI: 10.1016/j.transproceed.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/16/2019] [Accepted: 10/06/2019] [Indexed: 01/21/2023]
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Affiliation(s)
- Monir Moniruzzaman
- Department of AnthropologyMichigan State University 655 Auditorium Road East Lansing MI 48824 USA
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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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Affiliation(s)
- H J Ahn
- Department of Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - O J Kwon
- Department of Surgery, College of Medicine, Han Yang University, Seoul, Korea
| | - C Ahn
- Division of Nephrology, College of Medicine, Seoul National University, Seoul, Korea
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van Balen LJ, Ambagtsheer F, Ivanovski N, Weimar W. Interviews With Patients Who Traveled From Macedonia/Kosovo, The Netherlands, and Sweden for Paid Kidney Transplantations. Prog Transplant 2016; 26:328-334. [DOI: 10.1177/1526924816667951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patients travel worldwide for paid kidney transplants. Although transplantations abroad are not always illegal, they are commonly perceived to be illegal and unethical involving risks. Aim: We aimed to describe the motivations and experiences of patients who traveled abroad for paid kidney transplantations and to examine how these transplantations were facilitated. Methods: We interviewed 22 patients who traveled from Macedonia/Kosovo, the Netherlands, and Sweden for paid kidney transplantations between years 2000 and 2009. Results: Patients traveled because of inadequate transplant activity in their domestic countries and dialysis-related complaints. However, 6 patients underwent preemptive transplantations. Cultural factors such as patients’ affinity with destination countries, feelings of being discriminated against by the health-care system, and family ties also help explain why patients travel abroad. Seven of the 22 patients went to their country of origin. They were able to organize their transplantations by arranging help from family and friends abroad who provided contacts of caregivers there and who helped cover the costs of their transplants. The costs varied from €5000 to €45 000 (US$6800-US$61 200). Seven patients paid the hospital, 5 paid their doctor, 4 paid a broker, and 6 paid their donors. Conclusion: Research should include interviews with brokers, transplant professionals, and other facilitators to achieve a full picture of illegally performed transplantations.
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Affiliation(s)
- L. J. van Balen
- Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands
| | - Frederike Ambagtsheer
- Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands
| | - N. Ivanovski
- University of St Cyril and Methodius, Medical Faculty Skopje, Republic of Macedonia
| | - W. Weimar
- Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands
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