‘Medical tourism’ initiatives should exclude commercial organ transplantation

Abstract

The medical tourism industry is in a period of rapid global expansion. Hospitals and clinics in Argentina, Brazil, Costa Rica, the Dominican Republic and Mexico advertise inexpensive cosmetic surgery packages. Clinics in Hungary, Poland, the Czech Republic and elsewhere in Eastern Europe market low cost dental care. Medical facilities in India, Indonesia, Malaysia, the Philippines, Singapore and Thailand target the international patient market. Helping draw patients to these countries are medical tourism companies. These businesses advertise procedures to clients seeking affordable medical care or trying to avoid delays in receiving treatment within their local communities. In some countries, individual hospitals or private hospital chains are the main drivers behind efforts to attract international patients. In other regions, well-coordinated government programs and public-private initiatives are designed to increase market share of medical travellers. Participants in the global healthcare marketplace include travel agencies, public hospitals, private medical facilities, stand-alone clinics, government ministries, medical tourism companies, airlines, hotel chains and patients. Whatever the general advantages and disadvantages of a global marketplace in health services, many risks accompany the inclusion of organ transplant packages among the medical procedures sold to international patients. These dangers are magnified in countries where kidneys are purchased in underground economies or black markets. In these settings, promoting organ transplant packages to international patients risks escalating the number of kidneys purchased from poor citizens. Growing demand for transplants prompts organ brokers to increase the number of kidneys bought from impoverished individuals and sold to international patients. The World Health Organization identifies Colombia, India, Pakistan and the Philippines as four of the leading global hot spots for buying and selling human organs. The sale of organs is illegal in Colombia, India and Pakistan. Organ trafficking is illegal in the Philippines. Despite legislation intended to prevent the sale of organs in these countries, patients from around the world continue to purchase kidneys in these nations. Medical tourism campaigns exacerbate this problem by marketing ‘all-inclusive’ organ transplant packages to international patients. These operations include kidneys purchased from poor individuals rather than obtained from living donors or deceased persons. In India, the Ministry of Tourism’s Incredible India website advertises kidney transplants and notes the comparatively ‘cheap’ price of renal transplants at Indian medical facilities. In Pakistan, individual clinics advertise the sale of kidney transplants. In the Philippines, government agencies, hospitals and medical tourism companies all market organ transplants to international patients. Given the few kidneys available from living donors and deceased donors, coupled with the country’s well-known trade in organs, most of the kidneys sold within all-inclusive transplant packages are purchased from poor Filipinos. Neighbourhood organ brokers facilitate this trade in kidneys. The Philippine Medical Tourism Program was established in 2004. The public-private initiative includes government medical centres, private hospitals, various clinics, and the Philippine government Departments of Trade and Industry, Tourism and Health. Philippine government agencies promote the sale of transplant packages to international patients. For example, the website of the Philippine Information Agency touts the low price of kidney transplants at Philippine hospitals. It states, ‘while kidney transplants can reach up to $150,000 abroad, it will only cost $25,000 here’. Government representatives and Philippine physicians are trying to increase the number of patients from Saudi Arabia obtaining kidney transplants in the Philippines. Transplant DECLARATIONS