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Transplant Surgery Abroad Rife With Risks

Transplant Surgery Abroad Rife With Risks Researchers Find Higher Rates of Rejection, Infection; Cite Lack of Proper Controls Abroad WebMD Health News By Bill Hendrick Reviewed by Louise Chang, MD...

Oct. 16, 2008 -- Having surgery abroad can be a risky proposition for "transplant tourists" from the United States who go overseas to get kidneys to avoid long waiting lists, a new study says.

It's estimated that hundreds of U.S. residents go abroad annually for such operations, Jagbir Gill, MD, lead author of the study and a kidney specialist at the University of British Columbia, tells WebMD.

Most of his fellow researchers were scientists at the University of California, Los Angeles (UCLA), where Gill was, until recently, a post-graduate fellow.

Gill said people who leave the country for kidney transplants experience more severe postoperative complications, more serious infections, and a higher incidence of acute rejection.

Gill says he and colleagues studied the outcomes of kidney transplant recipients who had seen doctors at UCLA before traveling abroad and returned there after surgery overseas.

They compared the conditions of the transplant tourists to similar patients who underwent both transplantation and follow-up care at UCLA. The study included 33 people who went abroad for kidneys and 66 UCLA-transplanted patients.

A year after their operations, kidney rejection occurred in 30% of those who went abroad, compared with 12% of the patients operated on at UCLA. The severity and types of infections also were worse.

Twenty-seven percent of those who went abroad were hospitalized with infection listed as the primary cause, compared with 9% of the UCLA-treated patients.

One transplant tourist died of liver failure, probably as a consequence of donor-contracted hepatitis B.

The report, published in the November issue of the Clinical Journal of the American Society of Nephrology, said 42% of the transplant tourists studied had surgeries in China, 18% in Iran, 12% in the Philippines, and 9% in India. Pakistan, Peru, Egypt, Turkey, Mexico, and Thailand each accounted for 3%.

There's good reason transplant tourism is on the rise, says Gerald Lipshutz, MD, a UCLA surgeon and member of the study team.

At least 70,000 people in the U.S. are waiting for a kidney transplant at any given time, but there are only about 10,000 of the procedures performed a year. The average wait is at least five years, Lipshutz says.

The buying and selling of human tissue is illegal in the United States, but it's not unlawful for people to go abroad to buy organs, Lipshutz says.

"It's a big risk for people who go abroad, but it's also a big ethical issue," Lipshutz tells WebMD, adding that it's likely some organs transplanted overseas come from prisoners.

In a news release accompanying the study, the researchers say the higher incidence of infectious complications in those who went abroad "may reflect a number of issues related to tourism, including difficulties maintaining and monitoring immunosuppression during the transition of care."

Other factors for poorer outcomes include "the lack of preventive care for infections early after transplantation, the varying infectious disease characteristics of different countries, and the unclear means of selecting donors in many of these cases," it says.

The researchers could not determine how many tourists received kidneys from vendors. Some received kidneys from deceased humans, and at least two from blood relatives.

"Most of those people are desperate to be off dialysis," Lipshutz says, "so they go overseas."

Allan Kirk, MD, of Emory University in Atlanta, says the study clearly showed the danger of overseas transplants.

"Moving to an environment that is just sewing a kidney in doesn't take advantage of a multidisciplinary team approach" patients need, Kirk says.

Kidney transplantation isn't "thoroughly vetted" overseas as it is in the U.S., he says.

About 20 million Americans have some evidence of chronic kidney disease and are at risk of developing kidney failure, according to the American Society of Nephrology. Some 485,000 Americans require ongoing treatment, such as dialysis.

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