PAID LIVING ORGAN TRANSPLANTATION RESULTS IN UNACCEPTABLY HIGH RECIPIENT MORBIDITY AND MORTALITY

Abstract

O346 Aims: The ethical debate surrounding the payment of living unrelated donors continues despite very little evidence regarding the outcome. The aim of this study was to quantify identify the extent of the problem and to provide data on the outcome of patients undergoing these procedures. In general the supply of cadaveric donor kidneys for transplantation is exceeded by a higher demand of patients with end stage renal failure requiring transplants. This may be further exacerbated in certain groups, particularly immigrant populations, by matching schemes which discriminate against such patients due to blood group and HLA differences with the donor pool. Within our region there is a large Indo-Asian population with a high demand for renal replacement therapy and transplantation. Members of this community have a limited chance of receiving a transplant for several reasons: cadaveric donation rates are poor in this group and despite large family networks our attempts at encouraging live donation have been unsuccessful. Subsequently, often following prolonged waiting times for a transplant, some of these patients resort to travelling to Indo-Asia, against medical advice, to procure an unrelated donor kidney transplant. Methods: Following the initial study within our region, we conducted a national audit, whereby a postal questionnaire was sent to all UK transplant units. Seventeen of these units responded, 12 of which reported that patients had been transplanted overseas, all of them being in Asia from paid donors. Results: In total 23 patients were identified as having procured a kidney from an overseas source. In no case was medical advice sought in the UK prior to procurement. Mortality was high in this group with eight of the 23 (35%) patients dying from causes directly related to transplantation. Graft loss was also high with a further five (33%) of the surviving patients losing their transplanted kidney. The overall rate of successful transplants from this group of patients was only 44% (overall graft loss was 56%) in the short term. The information provided from the transplanting centre was inadequate in all cases with only one patient returning with details of their treatment. No patients had any documentation regarding donor details. Conclusion: These results reinforce the standpoint that organ trading is associated with unacceptable risks and poor outcomes. Furthermore, they are almost certainly an under-estimate of the on-going situation The basis of this trade in organs is based on monetary rather than clinical criteria. This exploitation of both donor and recipient lead us to conclude that this practice cannot be endorsed and even the most desperate dialysis patients should be reminded of the unacceptable risks involved in this practice.