Directed altruistic kidney donors from overseas mask transplant tourism

Abstract

1 NHS Blood and Transplant. Annual report on kidney transplantation. http://www.odt.nhs. uk/pdf/organ_specifi c_report_kidney_2014. pdf (accessed Feb 11, 2015). 2 Human Tissue Authority. Guidance to transplant teams and independent assessors. September, 2012. https://www.hta.gov.uk/ sites/default/fi les/Guidance_to_Transplant_ Teams_and_Independent_Assessors.pdf (accessed Feb 12, 2015). 3 NHS Commissioning Board. Commissioning policy statement: reimbursement of expenses for living kidney donors. April, 2013. www.england.nhs.uk/wpcontent/uploads/2013/04/a07-ps-a.pdf (accessed Feb 12, 2015). 4 Steering Committee of the Istanbul Summit. Organ traffi cking and transplant tourism and commercialism: the Declaration of Istanbul. Lancet 2008; 372: 5–6. 5 NHS Blood and Transplant. Living donor kidney transplantation 2020: a UK strategy. May 22, 2014. http://www.nhsbt.nhs.uk/ download/board_papers/may14/LivingKidney-Donor-transplantation-2020-A-UKStrategy.pdf (accessed Feb 12, 2015). for black, Asian, and ethnic minority patients with end-stage kidney disease, especially in the context of prolonged wait for kidneys because of a scarcity in compatible donors. Overseas donors can even claim for reimbursement from commissioners for costs undertaken to facilitate transplantation in the UK, which is counterbalanced by the overwhelming cost effectiveness of kidney transplantation versus dialysis. However, living kidney transplants for British recipients from distant relatives residing overseas with whom they have no emotional relationship is tantamount to reverse transplant tourism. Proving the existence of a relationship is easy but proving the non-existence of a genetic relationship, without DNA testing, is much harder. Coercion or financial reward for directed altruistic overseas donors are also impossible to categorically rule out. The Declaration of Istanbul makes a distinction between “travel for transplantation” and “transplant tourism”, and these lines are blurred for directed altruistic overseas donors. We also lack governance and oversight for processing directed altruistic donors from overseas. For example, the Human Tissue Authority merely requests a signed declaration from potential donors to be satisfied that the donor has not been offered a reward. This approach is not robust enough to protect against transplant tourism. The present national strategy spearheaded by NHS Blood and Transplant encourages health-care professionals to “work with the Home Offi ce and UK Border Agency to streamline and monitor UK Entry Visa processes for genuine cases of overseas donors”, with the plight of kidney patients from ethnic minorities specifically highlighted. I would argue that the only genuine overseas donor is an immediate close relative with an existing emotional relationship and that they should Primary Care and Clinical Sciences, University of Birmingham, Edgbaston B15 2TT, UK (MC, DK); Patient advocate, Bristol, UK (MvH); Psycho-oncology Co-operative Research Group, School of Psychology, and Sydney Medical School, University of Sydney, Sydney, NSW, Australia (MK); and Ottawa Hospital Research Institute, and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada (DM)