Commercial renal transplantation: A risky venture? A single Canadian centre experience

Abstract

Background: Canada, akin to other developed nations, faces thegrowing challenges of end-stage renal disease (ESRD). Even withexpanded donor criteria for renal transplantation (the treatment ofchoice for ESRD), the supply of kidneys is outpaced by the escalatingdemand. Remuneration for kidney donation is proscribedin Canada. Without an option of living-related transplantation(biological or emotional donors), patients often struggle with longwaiting lists for deceased donor transplantation. Accordingly, manypatients are now opting for more expedient avenues to obtaininga renal transplant. Through commercial organ retrieval programs,from living and deceased donors, patients are travelling outsideCanada to have the procedure performed.Methods: Between September 2001 and July 2007, 10 patients (7males, 3 females) underwent commercial renal transplantation outsideCanada. We describe the clinical outcomes of these patientsmanaged postoperatively at our single Canadian transplant centre.Results: Six living unrelated and 4 deceased donor renal transplantationswere performed on these 10 patients (mean age49.5 years). All procedures were performed in developing countriesand the postoperative complications were subsequently treatedat our centre. The mean post-transplant serum creatinine was142 mmol/L. The average follow-up time was 29.8 months (range:3 to 73 months). One patient required a transplant nephrectomysecondary to fungemia and subsequently died. One patient had afailed transplant and has currently resumed hemodialysis. Acuterejection was seen in 5 patients with 3 of these patients requiringre-initiation of hemodialysis. Only 1 patient had an uncomplicatedcourse after surgery.Discussion: Despite the kidney trade being a milieu of corruptionand commercialization, and the high risk of unconventionalcomplications, patients returning to Canada after commercial renaltransplantation are the new reality. Patients are often arriving withoutany documentation; therefore, timely, goal-directed therapy forsurgical and infectious complications is frequently delayed becauseof the time taken to establish an accurate diagnosis. Refuting theexistence of commercial renal transplantation may not be a practicalsolution; more consistent communication and documentationwith transplant teams may be more pragmatic. In the current climate,patients considering the option of overseas commercial renaltransplantation should be advised of the potential increased risks.