The American Medical Association's guidelines on medical tourism focus on best practices -- for example, the procedure must be voluntary, it can't limit the alternatives offered to patients, and patients should only be referred to accredited institutions.
While the United Network for Organ Sharing (UNOS)'s statement on medical tourism does maintain that the medical community has an obligation to provide care for these patients, it stops short of offering further direction to transplant programs.
Because of the dearth of guidance for dealing with specific problems that arise with transplant tourists, Schiano and Rhodes created some basic ethical principles.
They based their ideas on the understanding that physicians have a "professional obligation to promote the good of patients" as well as a "professional responsibility to adhere to medicine's commitment to nonjudgmental regard."
"We're supposed to take care of everybody, whatever their lot in life," Schiano said. "That has to be the overriding principle. We can't blame these people for trying to save their lives and getting transplanted."
Physicians shouldn't deny patients post-transplantation care, and they ought to provide emergent care at the very least. They may refer the patient to another transplant center for long-term follow up if they regard it as unethical to continue treatment.
"To turn your back on patients, especially if you know them before the transplant -- I don't agree with that," Schiano said. "It's the same thing in war. We treat the enemy soldier."
Patients should also be informed about the possibility of transplant tourism when they are not eligible for a transplant in the U.S. or when they are likely to die before reaching the top of the transplant list, Schiano and Rhodes wrote.
Schiano said that he'd rather have more information about centers abroad before referring patients there. He does, however, recommend that patients travel to other areas in the U.S. to get their transplant if they live in high-demand areas such as New York or California.
"There are geographic differences in terms of organ availability. For instance, you can go to Florida with the same [severity] score and blood type and be transplanted a lot sooner than you can in New York," Schiano said. "It's probably because more donors become available in certain areas of the country."
As for the 46-year-old patient who was transplanted in China, the Mount Sinai team decided a transplant program must treat all patients on the basis of their need, "regardless of what they might have done or how they secured their transplant organ."
"Although [the patient] had a long, complicated transplantation course," Schiano and Rosamond wrote, "he is currently doing well."
Mount Sinai has seen a total of nine patients who pursued transplants in China. Three of those had post-transplant problems but had been turned away elsewhere.
Seven of those nine patients have hepatitis B. Another three had had a renal transplant in India, and subsequently developed liver failure.