Physicians Must Treat 'Transplant Tourists'

Jan. 30, 2010— -- Patients who travel to foreign countries for organ transplants may return with more problems than they left with -- and physicians here have a moral responsibility to treat them, researchers asserted in a transplant journal.

"Medical tourism" has been on the rise as demand for organs outpaces supply and health care costs in the United States skyrocket, Dr. Thomas Schiano and Rosamond Rhodes of Mount Sinai School of Medicine reported in Liver Transplantation.

"If there were enough organs to go around, no one would go abroad to get transplanted," Schiano said. "In our practice, it clearly has increased over the last three to five years."

Researchers have estimated that 300 medical tourism transplants occurred between 2004 and 2006, with more than 40 percent of transplant tourists residing in New York or California, which have only 18 percent of the total U.S. population.

Yet physicians have had little guidance on delivering care to these patients, and some transplant centers may turn them away based on their actions.

"One of the liver transplant centers in our region, their policy is not to take on care of these patients, even if they were known to them before the transplant," Schiano said.

His questions about treatment arose with a 46-year-old Chinese patient who had been put on a waiting list for a liver transplant here because of end-stage liver disease.

The patient waited on the list for a year as his disease progressed from 18 points to 21 points on a 40-point severity scale.

Rather than wait any longer, the patient flew to China and had a liver transplant there.

Many transplanted organs in China come from executed prisoners, raising concerns about disease. Also, foreign transplants may be compromised by poor organ matching, unhealthy donors, and post-transplant infections. And some transplant centers abroad may use substandard surgical techniques.

Foreign centers are also less likely to send patients home with adequate records and education than centers here, the researchers said.