1
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Merhav H. Transplant tourism - a missed opportunity. Curr Opin Organ Transplant 2023; 28:457-462. [PMID: 37791523 DOI: 10.1097/mot.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW To explore the resurgence of transplant tourism (TT) despite the recent reiteration of the Declaration of Istanbul (DoI) in 2018. As demand grows exponentially and supply remains static, novel approaches to bridging the gap should be explored. RECENT FINDINGS TT is estimated to comprise up to 10% of transplants worldwide. Prosecuting patients seeking organs through TT has been unsuccessful. Extra jurisdictional prosecution of brokers, vendors and institutions participating in illicit TT has been difficult. Resurgence of TT has occurred in both "traditional" and new countries. The public attitude towards TT and paid donation is largely positive. The Iranian experience with state regulated paid donors merits attention and perhaps emulation. Numerous philosophers, ethicists and transplant professionals find it acceptable to promote financial consideration for organ donors. SUMMARY Acknowledging the autonomy of persons, including poor and vulnerable ones, to receive financial consideration for their sacrifice should not be considered morally reprehensible. Strict international regulation, oversight and legislation should be implemented to assure adequate compensation, donor wellbeing, elimination of brokers and excellent medical care. Implementing such a system internationally may eliminate kidney waiting lists, provide great benefits to vendors, improve transplant facilities in developing countries and provide substantial savings to insurers.
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Affiliation(s)
- Hadar Merhav
- Transplantation Unit, Soroka Medical Center, Ben Gurion University Medical School, Beer Sheba, Israel
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2
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Gill J, Clark S, Gill G, Gill J, Richardson C. A Survey Study to Examine Willingness to Travel for Transplantation and Consider Commercial Transplantation Among a Multi-Ethnic Cohort of Canadians. Kidney Int Rep 2023; 8:898-906. [PMID: 37069985 PMCID: PMC10105248 DOI: 10.1016/j.ekir.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/10/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Travel for transplantation is the movement of organs, donors, recipients, or transplant professionals across jurisdictional borders for transplantation purposes and is considered transplant tourism if transplant commercialism is involved. Little is known about the willingness of patients at risk for transplant tourism to engage in this practice. Methods A cross-sectional survey of patients with end-stage renal disease was conducted in Canada to determine interest in travel for transplantation and transplant tourism, characterize patients according to their willingness to consider transplant tourism, and identify factors to deter willingness to consider transplant tourism. Surveys were conducted face-to-face and in multiple languages. Results Among the 708 patients surveyed, 418 (59%) reported a willingness to travel outside of Canada for transplantation, with 24% reporting a strong willingness. One hundred sixty-one (23%) reported a willingness to travel and purchase a kidney overseas. On multivariate analysis, male sex, younger age, and Pacific Islander ethnicity were associated with higher odds of willingness to travel for transplant, whereas male sex, annual income greater than $100,000, and Asian and Middle Eastern ethnicity were associated with higher odds of willing to travel to purchase a kidney. Willingness reduced when respondents were informed of medical risks and legal implications related to travel for transplantation. Financial and ethical considerations were less effective at reducing willingness to travel for transplantation. Conclusion There was a high level of interest in travel for transplantation and transplant tourism. Legal consequences and education on medical risks of transplant tourism may be effective deterrent strategies.
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Affiliation(s)
- Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences University of British Columbia, Vancouver, Canada
- Correspondence: Jagbir Gill, Division of Nephrology University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z1Y6, Canada.
| | - Stephanie Clark
- Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Gurleen Gill
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences University of British Columbia, Vancouver, Canada
| | - Chris Richardson
- Centre for Health Evaluation and Outcomes Sciences University of British Columbia, Vancouver, Canada
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3
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Altheaby A, Owaidah K, Alotaibi A, Salem R, Algain R, Alotaibi A, Alnasrullah A, Shaheen MF, Tawhari M, Abdulgadir M. Graft and Patient Outcomes of Kidney Transplant Tourism: A Single-Center Experience. Avicenna J Med 2022; 12:120-126. [PMID: 36092382 PMCID: PMC9458345 DOI: 10.1055/s-0042-1750715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background
The supply-demand mismatch between organ donor and patient waiting for transplant has led to the growth of transplant tourism. This type of transplant is considered unethical and illegal, as it is usually performed in poor environments and carries a higher risk of infectious, vascular, and immunological complications.
Methods
In this single-centered retrospective cohort study, we compared patients who underwent transplant tourism to patients who were transplanted locally and followed up in our hospital from January 2015 to December 2018.
Result
A total of 254 local transplants and 60 patients from the transplant tourism group were included. Transplant tourism recipients were younger otherwise both groups were similar in gender, body mass index, diabetes, and hypertension. Recipients in the transplant tourism group had a significantly higher rate of delayed graft function (18.3% vs. 6.3%,
p
0.005), acute rejection (40% vs. 7.9%,
p
< 0.001), and higher posttransplant infection in general. With more urological complications and higher graft failure at 3-years' follow-up (11.7% vs. 0.8%,
p
< 0.001).
Conclusion
Transplant tourism is associated with a higher risk of infection and poor graft outcomes. Extra efforts are required to cut down transplant tourism by educating patients about its clinical risk and ethical considerations. In addition, measures to increase the number of deceased donor pool to provide a better alternative options for patients are essential.
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Affiliation(s)
- Abdulrahman Altheaby
- Department of Organ Transplant Center and Hepatobiliary Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Kenana Owaidah
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Aljowharah Alotaibi
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Rahaf Salem
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Rihaf Algain
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Areij Alotaibi
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmad Alnasrullah
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed F. Shaheen
- Department of Organ Transplant Center and Hepatobiliary Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed Tawhari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohamad Abdulgadir
- Department of Organ Transplant Center and Hepatobiliary Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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4
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Rickenbach ON, Tumin D, Mendez LMG, Beng H. Factors associated with follow-up outside a transplant center among pediatric kidney transplant recipients. Pediatr Nephrol 2022; 37:1915-1922. [PMID: 35015122 DOI: 10.1007/s00467-021-05397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Transfer of follow-up care after pediatric kidney transplantation (KTx) may jeopardize quality of care and patient outcomes. We sought to determine if minority status and socioeconomic factors were associated with increased likelihood of follow-up outside a transplant center, and whether this transition of care was associated with worse long-term graft and patient survival. METHODS We performed an analysis of the United Network for Organ Sharing database, including children age < 18 years who received a kidney transplant between 2003 and 2018. Survival analysis (conditional on survival with functioning graft to 1 year) was performed using a Cox proportional hazards model where transfer of care (place of follow-up recorded as any setting other than a transplant center) was entered as a time-varying covariate. RESULTS The study included 10,293, of whom 2083 received care outside of a transplant center during follow-up. Medicare coverage, but not minority race/ethnicity or socioeconomic status, was associated with increased likelihood of follow-up outside a transplant center. Follow-up outside a transplant center was associated with a 10% increased hazard of death or graft failure (hazard ratio: 1.10; 95% confidence interval: 1.004, 1.21; p = 0.041). CONCLUSION Follow-up outside of a transplant center increased risk of poor outcomes, though the likelihood of receiving care outside a transplant center did not vary by race/ethnicity or socioeconomic status. Our results highlight the need to improve continuity of care after KTx and to further understand the mechanisms leading to poor survival rates among minority populations. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Olivia Nieto Rickenbach
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27858, USA.
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27858, USA
| | - Liliana Michelle Gomez Mendez
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27858, USA
| | - Hostensia Beng
- Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27858, USA
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5
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Liman H, Makusidi M, Sakajiki A. Kidney transplant-related medical tourism in patients with end-stage renal disease: A report from a renal center in a developing nation. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_17_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Abstract
PURPOSE OF REVIEW To outline the impact of transplant tourism on the type and severity of post-transplant infections that may be seem in returning transplant tourists. This review outlines infections that might be expected and provides recommendations on screening tests that may assist in the diagnosis and management of such patients. RECENT FINDINGS Transplant tourists may develop unusual or resistant infections that pose a public health risk in their home country. The practice of transplant tourism is associated with a significantly increased risk of surgical and infectious complications after transplant. Returning transplant tourists require a thorough evaluation for active and latent infections. Transplant centers must be vigilant for new and emerging pathogens in this population.
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Affiliation(s)
- Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th St., Suite 842 (R-21), Miami, FL, 33136, USA.
| | - Elmi Muller
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa
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7
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Bastani B. The present and future of transplant organ shortage: some potential remedies. J Nephrol 2019; 33:277-288. [PMID: 31399908 DOI: 10.1007/s40620-019-00634-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 12/24/2022]
Abstract
Transplantation remains the modality of choice for patients with end stage renal disease (ESRD). However, while there has been a steady rise in the number of patients with ESRD the supply of donors (combine living and deceased) has fallen far behind the need, resulting in an increasing number of qualified patients remaining on the wait-list, and thousands being removed from the list every year because of death or becoming too sick for transplantation. This has also fed to transplant tourism around the world. Several countries have implemented a variety of policies to overcome their organ shortage that are presented in this article. There is an urgent need for developing policies geared to the cultural norms of different societies and universally accepted ethical principles to remedy this public health issue.
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Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University Hospital, Saint Louis University School of Medicine, 3635 Vista Avenue, Saint Louis, MO, 63110, USA.
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8
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Koons B, Moriarty H, Kear TM, Thomas AG, Henderson M. Factors Related to International Travel for Transplantation Among U.S.-Listed Kidney Transplant Candidates. Nephrol Nurs J 2019; 46:397-431. [PMID: 31490049 PMCID: PMC7008387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Factors related to travel for transplantation were examined using data from the Scientific Registry for Transplant Recipients. Candidates who traveled abroad for a kidney transplant had higher odds of being male, Asian or Hispanic, college-educated, employed, privately insured, and a non-U.S. citizen/non-U.S. resident. Candidates with a body mass index greater than 30, a calculated panel reactive antibody (cPRA) greater than 80%, and a history of more than two years of hemodialysis or peritoneal dialysis had lower odds of traveling abroad for a kidney transplant. Geographically, candidates listed in the northeastern region of the United States (New York and Western Vermont) had the highest odds of traveling abroad for a kidney transplant. Findings of this study can be used to guide practice and education with transplant candidates, and to direct further investigation in this understudied but growing area of transplantation.
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Affiliation(s)
- Brittany Koons
- Postdoctoral Research Fellow, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA
- Robert Wood Johnson Foundation Postdoctoral Research Fellow
| | - Helene Moriarty
- Professor, Diane and Robert Moritz Jr. Endowed Chair in Nursing Research, Villanova University, M. Louise Fitzpatrick College of Nursing, Villanova, PA
- Nurse Researcher, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Tamara M Kear
- Associate Professor of Nursing, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA
- Nursing Research Consultant, Main Line Health, Bryn Mawr, PA
- President of the American Nephrology Nurses Association
- Member of ANNA's Keystone Chapter
| | - Alvin G Thomas
- PhD Student, Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Macey Henderson
- Assistant Professor of Surgery, Johns Hopkins University, Baltimore, MD
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9
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Al Ammary F, Thomas AG, Massie AB, Muzaale AD, Shaffer AA, Koons B, Qadi MA, Crews DC, Garonzik-Wang J, Fang H, Brennan DC, Lentine KL, Segev DL, Henderson ML. The landscape of international living kidney donation in the United States. Am J Transplant 2019; 19:2009-2019. [PMID: 30615253 PMCID: PMC6591087 DOI: 10.1111/ajt.15256] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/31/2018] [Accepted: 01/01/2019] [Indexed: 01/25/2023]
Abstract
In the United States, kidney donation from international (noncitizen/nonresident) living kidney donors (LKDs) is permitted; however, given the heterogeneity of healthcare systems, concerns remain regarding the international LKD practice and recipient outcomes. We studied a US cohort of 102 315 LKD transplants from 2000-2016, including 2088 international LKDs, as reported to the Organ Procurement and Transplantation Network. International LKDs were more tightly clustered among a small number of centers than domestic LKDs (Gini coefficient 0.76 vs 0.58, P < .001). Compared with domestic LKDs, international LKDs were more often young, male, Hispanic or Asian, and biologically related to their recipient (P < .001). Policy-compliant donor follow-up was substantially lower for international LKDs at 6, 12, and 24 months postnephrectomy (2015 cohort: 45%, 33%, 36% vs 76%, 71%, 70% for domestic LKDs, P < .001). Among international LKDs, Hispanic (aOR = 0.23 0.360.56 , P < .001) and biologically related (aOR = 0.39 0.590.89 , P < .01) donors were more compliant in donor follow-up than white and unrelated donors. Recipients of international living donor kidney transplant (LDKT) had similar graft failure (aHR = 0.78 0.891.02 , P = .1) but lower mortality (aHR = 0.53 0.620.72 , P < .001) compared with the recipients of domestic LDKT after adjusting for recipient, transplant, and donor factors. International LKDs may provide an alternative opportunity for living donation. However, efforts to improve international LKD follow-up and engagement are warranted.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashton A Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Brittany Koons
- Department of Nursing, Villanova University, Villanova, Pennsylvania
| | - Mohamud A Qadi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Hai Fang
- Department of Health Systems, Management and Policy, University of Colorado School of Public Health, Aurora, Colorado
| | - Daniel C Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Krista L Lentine
- Department of Medicine, Saint Louis University, St. Louis, Missouri
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
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10
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Buchan CA, Kotton CN. Travel medicine, transplant tourism, and the solid organ transplant recipient-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13529. [PMID: 30859623 DOI: 10.1111/ctr.13529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review recommendations for prevention and management of travel-related infection in solid organ transplant (SOT) recipients as well as risks associated with transplant tourism. Counseling regarding travel post-transplant should be included during the pre-transplant evaluation, and all SOT recipients should be seen by a travel medicine specialist prior to traveling to destinations with higher rates of infection. Patients should be advised on vaccine-preventable illnesses as well as any need for prophylaxis (ie, malaria) based on their individual travel itineraries. Information with regards to specific recommendations for vaccines and prophylactic medications, along with drug-drug interactions, is summarized. Counseling should be provided for modifiable risks and exposures (ie, food and water safety, and insect bite prevention) as well as non-infectious travel topics. These guidelines also briefly address risks associated with transplant tourism and specific infections to consider if patients seek care for transplants done in foreign countries.
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Affiliation(s)
- C Arianne Buchan
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Camille Nelson Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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11
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Stewart J, Newman GS, Jain R, Bryan A, Berger H, Montenovo M, Bakthavatsalam R, Kling CE, Sibulesky L, Shalhub S, Limaye AP, Fisher CE, Rakita RM. Transplant tourism complicated by life-threatening New Delhi metallo-β-lactamase-1 infection. Am J Transplant 2019; 19:1224-1228. [PMID: 30282120 PMCID: PMC6436391 DOI: 10.1111/ajt.15136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/02/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
Abstract
Transplant tourism, which is the practice of traveling to other countries for transplant, continues to be a major problem worldwide. We describe a patient who traveled to Pakistan and underwent commercial kidney transplant. He developed life-threatening infections from New Delhi metallo-β-lactamase-1-producing Enterobacter cloacae and Rhizopus oryzae, resulting in a necrotizing kidney allograft infection and subsequent external iliac artery rupture. He survived after a prolonged course of nonstandardized antimicrobial therapy, including a combination of aztreonam and ceftazidime-avibactam, and aggressive surgical debridement with allograft nephrectomy. The early timing of infection with these unusual organisms localized to the allograft suggests contamination and substandard care at the time of transplant. This case highlights the challenges of caring for these infections and serves as a cautionary tale for the potential complications of commercial transplant tourism.
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Affiliation(s)
- Jenell Stewart
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Gretchen Snoeyenbos Newman
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Rupali Jain
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.,Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Andrew Bryan
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Heather Berger
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Martin Montenovo
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Ramasamy Bakthavatsalam
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Catherine E. Kling
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Lena Sibulesky
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, Washington, USA
| | - Sherene Shalhub
- Department of Surgery, Division of Vascular Surgery, University of Washington, Seattle, Washington, USA
| | - Ajit P. Limaye
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Cynthia E. Fisher
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Robert M. Rakita
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
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12
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Nellore A, Fishman JA. Donor-derived infections and infectious risk in xenotransplantation and allotransplantation. Xenotransplantation 2019; 25:e12423. [PMID: 30264880 DOI: 10.1111/xen.12423] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 01/06/2023]
Abstract
Post-transplantation infections are common in allograft recipients and should be expected in all immunocompromised hosts. Based on the need for immunosuppression in xenotransplantation, procedures developed to enhance safety in allotransplantation can be applied in future xenotransplantation clinical trials. Standardized approaches can be developed to guide the evaluation of common infectious syndromes in xenograft recipients. The opportunity created by screening of swine intended as xenograft donors has equal applicability to allotransplantation-notably broader screening strategies for allograft donors such as use of advanced sequencing modalities including broad-range molecular probes, microarrays, and high-throughput pyrosequencing. Considerations in management of allotransplant- and xenotransplant-associated infections are largely the same. Experience in xenotransplantation will continue to inform thinking regarding donor-derived infections in allotransplantation. We expect that experience in managing complex allotransplant recipients will similarly inform clinical trials in xenotransplantation.
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Affiliation(s)
- Anoma Nellore
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jay A Fishman
- Transplant and Compromised Host Infectious Disease Program and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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13
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AlBugami MM, AlOtaibe FE, Alabadi AM, Hamawi K, Bel'eed-Akkari K. Transplant tourism following the declaration of Istanbul: Poor outcomes and nephrologist dilemma. Nephrology (Carlton) 2018; 23:1139-1144. [DOI: 10.1111/nep.13181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Meteb M AlBugami
- Multi-Organ Transplant Center; King Fahad Specialist Hospital; Dammam Saudi Arabia
- Department of Internal Medicine, College of Medicine; University of Dammam; Dammam Saudi Arabia
| | - Fahad E AlOtaibe
- Multi-Organ Transplant Center; King Fahad Specialist Hospital; Dammam Saudi Arabia
- Department of Internal Medicine, College of Medicine; University of Dammam; Dammam Saudi Arabia
| | - Abdulnaser M Alabadi
- Multi-Organ Transplant Center; King Fahad Specialist Hospital; Dammam Saudi Arabia
| | - Khaled Hamawi
- Multi-Organ Transplant Center; King Fahad Specialist Hospital; Dammam Saudi Arabia
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14
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Deterrents to Organ Donation: A Multivariate Analysis of 766 Survey Respondents. J Am Coll Surg 2018; 226:414-422. [DOI: 10.1016/j.jamcollsurg.2017.12.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
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15
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Al Riyami MS, Al Saidi S, Al Ghaithi B, Al Maskari A, Lala S, Mohsin N, Hirshikesan L, Al Kalbani N. Pediatric Renal Transplantation in Oman: A Single-center Experience. Oman Med J 2018; 33:7-14. [PMID: 29467993 DOI: 10.5001/omj.2018.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objectives This study sought to report 22 years experience in pediatric kidney transplantation in Oman. Methods Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation (including surgical complications, infections, graft rejection) graft and patient survival, and duration of follow-up. Results During the study period transplantation from 27 living related donors (LRDs), 42 living unrelated donors (LURDs), also referred to as commercial transplant, and one deceased donor were performed. The median age at transplantation was nine years for both groups. The most common primary diagnosis was congenital anomalies of the kidney and urinary tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal transplantation. Children who received LURD kidneys had high surgical complications (42.8%) compared to the LRDs group (17.8%). Five patients from LURDs group had early graft nephrectomy and four patients developed non-graft function or delayed graft function. In addition, patients in the LURDs group had a higher incidence of hypertension and acute rejection. Graft and patient survival were both better in the LRDs than the LURDs group. Conclusions Although our pediatric kidney transplant program is a young program it has had successful patient outcomes comparable to international programs. Our study provides evidence that in addition to legal and ethical issues with commercial transplant, it also carries significantly higher morbidity and reduced graft and patient survival.
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Affiliation(s)
- Mohamed S Al Riyami
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Sulaiman Al Saidi
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Badria Al Ghaithi
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Anisa Al Maskari
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
| | - Sadiq Lala
- Urology Unit, Department of Surgery, Royal Hospital, Muscat, Oman
| | - Nabil Mohsin
- Department of Medicine, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Lekha Hirshikesan
- Department of Nephrology Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Naifain Al Kalbani
- Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat, Oman
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Donor-derived infections in solid organ transplant patients: toward a holistic approach. Curr Opin Infect Dis 2018; 30:329-339. [PMID: 28538045 DOI: 10.1097/qco.0000000000000377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Solid organ demand far exceeds organ supply. Strategies to increase the donor pool include the liberalization of selection criteria without increasing the risk of unexpected donor-derived infection (DDI), a rare complication of transplantation carrying high morbidity and mortality. We review the challenging aspects in the prevention of DDI, focusing on the complexities of data sharing and efficient communication and the role infectious diseases specialists play in the process. RECENT FINDINGS Advances in donor screening, transmission recognition and reporting allow for a better estimation of the risk of DDI. However, there is great variability in the frequency and methods with which organ procurement organizations report transmission events.Moreover, the Scientific Registry of Transplant Recipients provides limited donor and recipient outcome infectious diseases related data. Infectious disease contribution to the allocation process has been found to improve organ donation efficiency and communication between involved parties. Although communication gaps are strongly associated with infection transmission (relative risk 2.36%, confidence interval 1.48-3.78), effective communication minimizes or prevents infection in transplant recipients (X(1) 13.13, P = 0.0003). SUMMARY Prospective research is still required to define optimal screening protocols and further prevent transmission of infection. A holistic approach is likely to result in enhanced transplantation safety. Toward this goal, development of standards of investigation; improvement in reporting and data sharing; and strategies ensuring coordinated and rapid communication among parties involved in the allocation process need to be pursued.
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17
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Adams MP. The Ethics of Organ Tourism: Role Morality and Organ Transplantation. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017; 42:670-689. [PMID: 29149331 DOI: 10.1093/jmp/jhx021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Organ tourism occurs when individuals in countries with existing organ transplant procedures, such as the United States, are unable to procure an organ by using those transplant procedures in enough time to save their life. In this paper, I am concerned with the following question: When organ tourists return to the United States and need another transplant, do US transplant physicians have an obligation to place them on a transplant list? I argue that transplant physicians have a duty not to relist organ tourists. Specifically, I contend that we should locate physicians' duties in these cases within the new role of "transplant physician." This role results from transplant physicians' participation in a system that depends on organ donors' voluntary act of donation.
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Affiliation(s)
- Marcus P Adams
- University at Albany, State University of New York, Albany, New York, USA
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18
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Gill JS, Wright AJ, Delmonico FL, Newell KA. Towards Improving the Transfer of Care of Kidney Transplant Recipients. Am J Transplant 2017; 17:54-59. [PMID: 27495956 DOI: 10.1111/ajt.13997] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients require specialized medical care and may be at risk for adverse health outcomes when their care is transferred. This document provides opinion-based recommendations to facilitate safe and efficient transfers of care for kidney transplant recipients including minimizing the risk of rejection, avoidance of medication errors, ensuring patient access to immunosuppressant medications, avoidance of lapses in health insurance coverage, and communication of risks of donor disease transmission. The document summarizes information to be included in a medical transfer document and includes suggestions to help the patient establish an optimal therapeutic relationship with their new transplant care team. The document is intended as a starting point towards standardization of transfers of care involving kidney transplant recipients.
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Affiliation(s)
- J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - A J Wright
- Division of Infectious Disease, University of British Columbia, Vancouver, British Columbia, Canada
| | - F L Delmonico
- Department of Surgery, Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - K A Newell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
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19
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Amira CO, Bello BT. Do the Benefits of Transplant Tourism Amongst Nigerian Patients Outweigh the Risks? A Single-Center Experience. Int J Organ Transplant Med 2017; 8:132-139. [PMID: 28924461 PMCID: PMC5592100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transplant tourism (TT) is the term used to describe travel outside one's country of abode for the sole purpose of obtaining organ transplantation services. OBJECTIVE This study describes the characteristics and outcomes of kidney transplant tourists who were followed up in our institution. METHODS A retrospective study was conducted on patients who underwent kidney transplantation outside the country and were followed up in our institution from 2007 to 2015. RESULTS 26 patients were followed up; 19 (73%) were males. The mean±SD age of patients was 40.5±10.3 years. The majority (n=20) of the transplantations were carried out in India. Living-unrelated transplants were most common (54%). Complications encountered were infections in 11 (42%) patients, new-onset diabetes after transplantation in 9 (35%), chronic allograft nephropathy in 8 (31%), biopsy-proven acute rejections in 3 (12%), and primary non-function in 2 (8%). 1-year graft survival was 81% and 1-year patient survival was 85%. CONCLUSION Kidney transplant tourism is still common among Nigerian patients with end-stage renal disease. Short-term graft and patient survival rates were poorer than values recommended for living kidney transplants. We therefore advise that TT should be discouraged in Nigeria, given the availability of transplantation services in the country, and also in line with international efforts to curb the practice.
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Affiliation(s)
- C. O. Amira
- Nephrology Unit, Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria,Correspondence: Christiana Oluwatoyin Amira, Department of Medicine, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria, Tel: +234-802-855-4566, E-mail:
| | - B. T. Bello
- Nephrology Unit, Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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20
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Ratkovic M, Jukic NB, Radunovic D, Prelevic V, Gledovic B. Kidney Transplantation Program in Montenegro. BANTAO JOURNAL 2016. [DOI: 10.1515/bj-2015-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction. There was no transplantation program in Montenegro until 2012. On the other hand, there were 93 patients with transplanted kidney. These transplantations were performed abroad; 15% in areas of black organ markets (India, Pakistan, Russian Federation). Beside the ethical problems, these transplantations carried a high risk of complications.
Methods. Our health system had to ensure solution for patients with terminal organ failure. Preparation of all neccessary conditions for the beginning of transplantation program in Montenegro started in 2006 with different activities including public, legal, medical, educational and international cooperation aspects.
Results. The first kidney transplantation from living donor in Montenegro was preformed on September 25th, 2012. In the period from 2012 until now 23 kidney transplantations from living related donor were performed and one kidney transplantation from deceased donor in the Clinical Center of Montenegro. In the a two year-follow-up period, all patients to whom kidney transplantation was performed are in a good condition and without serious complications in posttransplant period.
Conclusion. Development of the transplantation program allowed controlled transplantation and safety of patients. Our next steps are development of deceased organ donor transplantation and achievement of higher rate of deceased donor organ transplantation and individualization of immunosuppressive therapy.
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Affiliation(s)
- Marina Ratkovic
- Clinical Center of Montenegro, Nephrology and Hemodialysis Department, Podgorica, Montenegro
| | - Nikolina Basic Jukic
- Clinical Hospital Center Zagreb, Croatia, Nephrology, Arterial Hypertension, Dialysis and Transplantation Department, Zagreb, Croatia
| | - Danilo Radunovic
- Clinical Center of Montenegro, Nephrology and Hemodialysis Department, Podgorica, Montenegro
| | - Vladimir Prelevic
- Clinical Center of Montenegro, Nephrology and Hemodialysis Department, Podgorica, Montenegro
| | - Branka Gledovic
- Clinical Center of Montenegro, Nephrology and Hemodialysis Department, Podgorica, Montenegro
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21
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Ambagtsheer F, de Jong J, Bramer WM, Weimar W. On Patients Who Purchase Organ Transplants Abroad. Am J Transplant 2016; 16:2800-2815. [PMID: 26932422 DOI: 10.1111/ajt.13766] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/25/2023]
Abstract
The international transplant community portrays organ trade as a growing and serious crime involving large numbers of traveling patients who purchase organs. We present a systematic review about the published number of patients who purchased organs. With this information, we discuss whether the scientific literature reflects a substantial practice of organ purchase. Between 2000 and 2015, 86 studies were published. Seventy-six of these presented patients who traveled and 42 stated that the transplants were commercial. Only 11 studies reported that patients paid, and eight described to what or whom patients paid. In total, during a period of 42 years, 6002 patients have been reported to travel for transplantation. Of these, only 1238 were reported to have paid for their transplants. An additional unknown number of patients paid for their transplants in their native countries. We conclude that the scientific literature does not reflect a large number of patients buying organs. Organ purchases were more often assumed than determined. A reporting code for transplant professionals to report organ trafficking networks is a potential strategy to collect and quantify cases.
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Affiliation(s)
- F Ambagtsheer
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J de Jong
- Analysis and Research Department, Central Division of the National Police, Driebergen, the Netherlands.,Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W Weimar
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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22
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Záliš L, Maguire Á, Soforic K, Ruggeri K. Global Access to Health Care and Well-Being: A Place for Policy and Science. Front Public Health 2016; 4:129. [PMID: 27446895 PMCID: PMC4923068 DOI: 10.3389/fpubh.2016.00129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 06/08/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ladislav Záliš
- Department of Psychology, Faculty of Social Studies, Masaryk University , Brno , Czech Republic
| | - Áine Maguire
- Policy Research Group, Department of Psychology, University of Cambridge , Cambridge , UK
| | - Kristen Soforic
- Health Care Department, NORC at the University of Chicago , Chicago, IL , USA
| | - Kai Ruggeri
- Policy Research Group, Department of Psychology, University of Cambridge, Cambridge, UK; Engineering Design Centre, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
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23
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Prasad GVR, Ananth S, Palepu S, Huang M, Nash MM, Zaltzman JS. Commercial kidney transplantation is an important risk factor in long-term kidney allograft survival. Kidney Int 2016; 89:1119-1124. [PMID: 27083285 DOI: 10.1016/j.kint.2015.12.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/24/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
Transplant tourism, a form of transplant commercialization, has resulted in serious short-term adverse outcomes that explain reduced short-term kidney allograft survival. However, the nature of longer-term outcomes in commercial kidney transplant recipients is less clear. To study this further, we identified 69 Canadian commercial transplant recipients of 72 kidney allografts transplanted during 1998 to 2013 who reported to our transplant center for follow-up care. Their outcomes to 8 years post-transplant were compared with 702 domestic living donor and 827 deceased donor transplant recipients during this period using Kaplan-Meier survival plots and multivariate Cox regression analysis. Among many complications, notable specific events included hepatitis B or C seroconversion (7 patients), active hepatitis and/or fulminant hepatic failure (4 patients), pulmonary tuberculosis (2 patients), and a type A dissecting aortic aneurysm. Commercial transplantation was independently associated with significantly reduced death-censored kidney allograft survival (hazard ratio 3.69, 95% confidence interval 1.88-7.25) along with significantly delayed graft function and eGFR 30 ml/min/1.73 m(2) or less at 3 months post-transplant. Thus, commercial transplantation represents an important risk factor for long-term kidney allograft loss. Concerted arguments and efforts using adverse recipient outcomes among the main premises are still required in order to eradicate transplant commercialization.
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Affiliation(s)
- G V Ramesh Prasad
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Sailesh Ananth
- Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sneha Palepu
- Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael Huang
- Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle M Nash
- Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey S Zaltzman
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
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24
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Quach K, Sultan H, Li Y, Famure O, Kim SJ. Outcomes of Kidney Transplantation Abroad. Prog Transplant 2016; 26:5-12. [DOI: 10.1177/1526924816632133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context: An increasing demand for kidney transplantation has enticed some patients with end-stage renal disease (ESRD) to venture outside their country of residence, but their posttransplant outcomes may be suboptimal. Objective: We compared the risks and clinical outcomes among tourists, or patients who pursue a kidney transplant abroad, versus patients who received a transplant at the Toronto General Hospital (TGH). Methods: A single-center, 1:3 matched (based on age at transplant, time on dialysis, and year of transplant) cohort study was conducted. Forty-five tourists were matched with 135 domestic transplant recipients between January 1, 2000, and December 31, 2011. Multivariable Cox proportional hazards models were fitted to assess graft and patient outcomes. Results: Among the 45 tourists, the majority (38 of 45) traveled to the Middle East or Far East Asia, and most received living donor kidney transplants (35 of 45). Multivariable Cox proportional hazards models showed that tourists had a higher risk for the composite outcome of acute rejection, death-censored graft failure, or death with graft function (DWGF; hazard ratio [HR] 2.08, 95% confidence interval [CI]: 1.06-4.07). Tourists also showed a higher risk for the individual end points of acute rejection, DWGF, and posttransplant hospitalizations. Conclusion: Patients going abroad for kidney transplantation may have inferior outcomes compared to domestic patients receiving kidney transplants. Patients who are contemplating an overseas transplant need to be aware of the increased risk of adverse posttransplant outcomes and should be appropriately counseled by transplant professionals during the pretransplant evaluation process.
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Affiliation(s)
- Kevin Quach
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Heebah Sultan
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Yanhong Li
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Olusegun Famure
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S. Joseph Kim
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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25
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Caulfield T, Duijst W, Bos M, Chassis I, Codreanu I, Danovitch G, Gill J, Ivanovski N, Shin M. Trafficking in Human Beings for the Purpose of Organ Removal and the Ethical and Legal Obligations of Healthcare Providers. Transplant Direct 2016; 2:e60. [PMID: 27500253 PMCID: PMC4946496 DOI: 10.1097/txd.0000000000000566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/18/2015] [Indexed: 11/25/2022] Open
Abstract
Physicians and other health care professionals seem well placed to play a role in the monitoring and, perhaps, in the curtailment of the trafficking in human beings for the purpose of organ removal. They serve as important sources of information for patients and may have access to information that can be used to gain a greater understanding of organ trafficking networks. However, well-established legal and ethical obligations owed to their patients can create challenging policy tensions that can make it difficult to implement policy action at the level of the physician/patient. In this article, we explore the role-and legal and ethical obligations-of physicians at 3 key stages of patient interaction: the information phase, the pretransplant phase, and the posttransplant phase. Although policy challenges remain, physicians can still play a vital role by, for example, providing patients with a frank disclosure of the relevant risks and harms associated with the illegal organ trade and an honest account of the physician's own moral objections. They can also report colleagues involved in the illegal trade to an appropriate regulatory authority. Existing legal and ethical obligations likely prohibit physicians from reporting patients who have received an illegal organ. However, given the potential benefits that may accrue from the collection of more information about the illegal transactions, this is an area where legal reform should be considered.
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, University of Alberta, University of Alberta, Edmonton, Canada
| | - Wilma Duijst
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mike Bos
- Eurotransplant International Foundation, Leiden, The Netherlands
| | | | | | | | - John Gill
- University of British Columbia, Vancouver, BC, Canada
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26
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Piccoli GB, Sacchetti L, Verzè L, Cavallo F. Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney? Philos Ethics Humanit Med 2015; 10:13. [PMID: 26684455 PMCID: PMC4683780 DOI: 10.1186/s13010-015-0033-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/05/2015] [Indexed: 05/08/2023] Open
Abstract
Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of "reverse" informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties.
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Affiliation(s)
- Giorgina Barbara Piccoli
- SS Nephrology, Department of Clinical and Biological Sciences University of Torino, Torino, Italy.
- AOU san Luigi Gonzaga, Regione Gonzole 10, Orbassano, Torino, Italy.
| | - Laura Sacchetti
- EBM Course, Torino Medical School, University of Torino, Torino, Italy.
| | - Laura Verzè
- EBM Course, Torino Medical School, University of Torino, Torino, Italy.
| | - Franco Cavallo
- EBM Course, Torino Medical School, University of Torino, Torino, Italy
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Abstract
Transplant tourism is commonly defined as travel abroad for the purpose of transplantation, but the term evokes ethical and legal concerns about commercial transplantation. Due to the mismatch in supply and demand for organs, transplant tourism has increased over the last several decades and now accounts for 10 % of transplants worldwide. Patients from the USA who pursue transplantation abroad do so most commonly for renal transplantation, and travel mostly to China, the Philippines, and India. Transplant tourism puts the organ recipient at risk for surgical complications, poor graft outcome, increased mortality, and a variety of infectious complications. Bacterial, viral, fungal, and parasitic infections have all been described, and most concerning are the high rates of blood-borne viral infections and invasive, often fatal, fungal infections. Transplant and infectious diseases physicians should have a high degree of suspicion for infectious complications in patients returning from transplantation abroad.
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Affiliation(s)
- Jennifer M Babik
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA,
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28
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The Rationale for Incentives for Living Donors: An International Perspective? CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-014-0045-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Global institutions, although suggesting measures to deter organ trafficking, reiterate the lack of official statistics about this illegal trade. In this article, we explore the reasons why organ trafficking remains unreported. We argue that the complex factors that perpetuate invisibility facilitate trafficked organs being "laundered" in the health care systems of the purchaser's country, hindering accurate estimation of the problem. The factors are as follows: (a) issues of globalization, jurisdiction, and law enforcement; (b) the power of health care professionals; (c) the reimbursement of transplantation costs abroad by insurers; (d) ambivalence of the victim status of the sellers; and (e) the buyers as vulnerable offenders.
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Outcomes of kidney transplant tourism and risk factors for de novo urothelial carcinoma. Transplantation 2014; 98:79-87. [PMID: 24879380 DOI: 10.1097/tp.0000000000000023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND To date, the outcomes of transplant tourism have not been reported extensively. In addition, data about the accuracy of urine cytology for the detection and the role of the BK virus (BKV) in the carcinogenesis of urothelial carcinoma (UC) after renal transplantation are lacking. METHODS Three hundred seven patients who received deceased donor kidney transplants between January 2003 and December 2009 were retrospectively studied. The clinical parameters and outcomes between the domestic and tourist groups were compared. We also investigated the risk factors and role of BKV in the carcinogenesis of de novo UC by quantitative real-time polymerase chain reaction. RESULTS The subjects in the tourist group were older at transplantation and had a shorter dialysis time before transplantation. There were significantly higher incidence rates of BKV viruria, Pneumocystis jiroveci pneumonia, and malignancy in the tourist group. Graft and patient survival were superior in the domestic group. A total of 43 cancers were identified, and the most common type of malignancy was UC (23 patients, 53.5%). The tourist group had a significantly higher incidence of tumors. The sensitivity and specificity of urine cytology for detecting UC were 73.9% and 94.7%, respectively. Independent predictors of UC included female sex, use of Chinese herbal medicine, and transplant tourism. Only two patients (8.7%) with UC had detectable BKV. CONCLUSIONS Transplant tourism was a risk factor for infection and de novo malignancy. Urothelial carcinoma was the most common malignancy after kidney transplantation. Regular screening for the early detection of UC by urine cytology or periodic sonographic surveys is mandatory, especially for those at high risk.
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Abstract
Unusual clinical syndromes or clusters of infections in recipients of organs from the same donor suggest donor-derived infection as a possible source of transmission The incidence of transmission of unexpected infection by organ allografts is low, but precise data are lacking Screening of donors for common pathogens involves both epidemiologic history and microbiological assays, and is highly effective for preventing the transmission of HIV and hepatitis B and C viruses Donor screening for uncommon pathogens must be guided by knowledge of changes in the local epidemiology of infection The key element in the detection of donor-derived infection is suspicion on the part of the clinicians caring for organ recipients Application of newer microbiological techniques will increase the speed of donor screening and enhance transplant safety
Each year, over 70,000 organs are transplanted worldwide. The degree of risk of transmission of infection from transplanted organs to the recipient is largely unknown and is difficult to assess for specific organs. Here, Jay A. Fishman and Paolo A. Grossi describe the major risk factors for organ donor-derived transmission of infection and discuss opportunities to reduce the incidence of such events. Organ transplantation, including of the heart, lung, kidney, liver, pancreas, and small bowel, is considered the therapy of choice for end-stage organ failure. Each year, over 70,000 organs are implanted worldwide. One donor may provide multiple organs, as well as corneas and other tissues, for multiple recipients. The degree of risk for transmission of infection carried with grafts, notably of viruses, is largely unknown and, for a specific organ, difficult to assess. The approach to microbiological screening of organ donors varies with national and regional regulations and with the availability and performance of microbiological assays used for potential donors. Transmission of both expected or common, and unexpected infections has been observed in organ transplants, generally recognized after development of clusters of infections among recipients of organs from a common donor. Other than for unusual or catastrophic events, few data exist that define the incidence and manifestations of donor-derived infections or the ideal assays to use in screening to prevent such transmissions. Absolute prevention of the transmission of donor-derived infections in organ transplantation is not possible. However, improvements in screening technologies will enhance the safety of transplantation in the future.
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Affiliation(s)
- Jay A Fishman
- Transplant Infectious Disease Program, Infectious Disease Division and MGH Transplantation Center, 55 Fruit Street, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114-2696, USA
| | - Paolo A Grossi
- National Centre for Transplantation, Infectious and Tropical Diseases Department, University of Insubria, Varese 21100, Italy
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Carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii: assessing their impact on organ transplantation. Curr Opin Organ Transplant 2014; 15:676-82. [PMID: 20930636 DOI: 10.1097/mot.0b013e3283404373] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This review highlights the impact of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii on patients who have undergone organ transplantation and explores both available and potential agents to treat infections caused by these multidrug-resistant (MDR) pathogens. RECENT FINDINGS Few antimicrobials exist to treat carbapenem-resistant Gram-negative infections, and resistance to salvage therapies is escalating. Organ transplantation appears to be a risk factor for infections with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Isolation of these MDR bacteria is increasing and may be associated with allograft failure and mortality. In the majority of cases, aminoglycosides, polymyxins, and tigecycline have been employed to treat these infections. Anecdotal successes exist but these antibiotics may be unreliable. Few novel agents are in development. SUMMARY Bacterial infections remain a leading cause of posttransplantation morbidity and mortality. Carbapenem resistance is a significant threat to allograft and patient survival. With few antimicrobials being developed, transplant centers may be forced to make decisions regarding surveillance, empiric antimicrobial regimens, and transplant candidacy in the setting of carriage of MDR pathogens. There is an urgent need for collaborative studies to address the clinical impact of these infections on transplantation.
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Rodríguez-Reimundes E, Soler-Pujol G, Díaz CH, Dávalos-Michel M, Jost LJ, Laham G, Vilches AR. Travel for transplantation and transplant commercialism in Argentina: a 4-decade experience from a University Hospital. Clin Transplant 2014; 28:377-82. [DOI: 10.1111/ctr.12323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Ezequiel Rodríguez-Reimundes
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Gervasio Soler-Pujol
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Carlos H. Díaz
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Mario Dávalos-Michel
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Luis J. Jost
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Gustavo Laham
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
| | - Antonio R. Vilches
- Nephrology and Transplantation Section; Department of Medicine; Hospital Universitario CEMIC; Buenos Aires Argentina
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Danovitch GM. The high cost of organ transplant commercialism. Kidney Int 2014; 85:248-50. [DOI: 10.1038/ki.2013.466] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 08/21/2013] [Accepted: 08/29/2013] [Indexed: 11/09/2022]
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Bagheri A, Delmonico FL. Guest editorial: Organ trafficking and transplant tourism: a call for international collaboration. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:885-886. [PMID: 23860691 DOI: 10.1007/s11019-013-9503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Alireza Bagheri
- Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran,
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Travel and transplantation: travel-related diseases in transplant recipients. Curr Opin Organ Transplant 2013; 17:594-600. [PMID: 23147910 DOI: 10.1097/mot.0b013e328359266b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Travel-related diseases may be seen in transplant recipients after travel, after transplant tourism, and via transmission from blood and organ donors, augmented by recent increases in travel, migration, and globalization. Such infections include tuberculosis, Plasmodium (malaria), Babesia, Trypanosoma cruzi (Chagas disease), Strongyloides, Coccidioides, Histoplasma, Leishmania, Brucella, HTLV, dengue, among numerous others. RECENT FINDINGS Review of cohorts of transplant recipients show that they tend to have minimal or suboptimal preparation prior to travel, with limited pretravel vaccination, medications, and education, which poses a greatly increased risk of travel-related infections and complications. The epidemiology of such travel-related infections in transplant recipients, along with methods for prevention, including vaccines, chemoprophylaxis, and education may help SOT recipients avoid travel-related infections, and are discussed in this review. SUMMARY Optimizing the understanding of the risk of tropical, geographically restricted, and other unusual or unexpected, travel-related infections will enhance the safety of vulnerable transplant recipients from potentially life-threatening infections.
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Abstract
Parasitic diseases are rare infections after a solid organ transplant (SOT). Toxoplasmosis, Trypanosoma cruzi, and visceral leishmanias are the 3 main opportunistic protozoal infections that have the potential to be lethal if not diagnosed early and treated appropriately after SOT. Strongyloides stercoralis is the one helminthic disease that is life-threatening after transplant. This review addresses modes of transmission, methods of diagnosis, and treatment of the most serious parasitic infections in SOT. The role of targeted pretransplant screening of the donor and recipient for parasitic diseases is also discussed.
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Affiliation(s)
- Laura O'Bryan Coster
- Department of Infectious Diseases, Georgetown University Hospital, Washington, DC 20007, USA.
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Kotton CN, Hibberd PL. Travel medicine and transplant tourism in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:337-47. [PMID: 23465026 DOI: 10.1111/ajt.12125] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C N Kotton
- Transplant Infectious Disease and Compromised Host Program; Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
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Cohen IG. Transplant tourism: the ethics and regulation of international markets for organs. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2013; 41:269-285. [PMID: 23581670 DOI: 10.1111/jlme.12018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
"Medical Tourism" is the travel of residents of one country to another country for treatment. In this article I focus on travel abroad to purchase organs for transplant, what I will call "Transplant Tourism." With the exception of Iran, organ sale is illegal across the globe, but many destination countries have thriving black markets, either due to their willful failure to police the practice or more good faith lack of resources to detect it. I focus on the sale of kidneys, the most common subject of transplant tourism, though much of what I say could be applied to other organs as well. Part I briefly reviews some data on sellers, recipients, and brokers. Part II discusses the bioethical issues posed by the trade, and Part III focuses on potential regulation to deal with these issues.
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Cohen IG. Can the government ban organ sale? Recent court challenges and the future of US law on selling human organs and other tissue. Am J Transplant 2012; 12:1983-7. [PMID: 22594492 DOI: 10.1111/j.1600-6143.2012.04092.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
On December 1, 2011, in Flynn v. Holder, a panel of the US Court of Appeals for the Ninth Circuit upheld the National Organ Transplant Act of 1984 (NOTA) from a constitutional challenge, but interpreted the act such that its prohibition on sale did not encompass "peripheral blood stem cells" obtained through apheresis. Rehearing of the case was denied on March 27, 2012. The Obama administration must now decide whether to pursue its challenge in the US Supreme Court. This article explains the litigation, its significance and uses it as a backdrop against which to understand the history and future trajectory of the laws governing selling organs and other human tissue.
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Affiliation(s)
- I G Cohen
- Harvard Law School and Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, MA, USA.
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Tong A, Chapman JR, Wong G, Cross NB, Batabyal P, Craig JC. The experiences of commercial kidney donors: thematic synthesis of qualitative research. Transpl Int 2012; 25:1138-49. [DOI: 10.1111/j.1432-2277.2012.01534.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ambagtsheer F, Zaitch D, van Swaaningen R, Duijst W, Zuidema W, Weimar W. Cross-border quest: the reality and legality of transplant tourism. J Transplant 2012; 2012:391936. [PMID: 22655168 PMCID: PMC3359720 DOI: 10.1155/2012/391936] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 12/02/2022] Open
Abstract
Background. Transplant tourism is a phenomenon where patients travel abroad to purchase organs for transplants. This paper presents the results of a fieldwork study by describing the experiences of Dutch transplant professionals confronted by patients who allegedly purchased kidney transplants abroad. Second, it addresses the legal definition and prohibition of transplant tourism under national and international law. The final part addresses the legal implications of transplant tourism for patients and physicians. Methods. The study involved seventeen interviews among transplant physicians, transplant coordinators and policy-experts and a review of national and international legislation that prohibit transplant tourism. Results. All Dutch transplant centers are confronted with patients who undergo transplants abroad. The estimated total number is four per year. Transplant tourism is not explicitly defined under national and international law. While the purchase of organs is almost universally prohibited, transplant tourism is hardly punishable because national laws generally do not apply to crimes committed abroad. Moreover, the purchase of organs (abroad) is almost impossible to prove. Conclusions. Transplant tourism is a legally complex phenomenon that warrants closer research and dialogue. The legal rights and obligations of patients and physicians confronted with transplant tourism should be clarified.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Section Transplantation, Erasmus Medical Centre, University Hospital, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Damián Zaitch
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, The Netherlands
| | - René van Swaaningen
- Criminology Department, Erasmus School of Law, Erasmus University Rotterdam, The Netherlands
| | - Wilma Duijst
- Department of Public Health, Radboud University Nijmegen, The Netherlands
| | - Willij Zuidema
- Department of Internal Medicine, Section Transplantation, Erasmus Medical Centre, University Hospital, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Section Transplantation, Erasmus Medical Centre, University Hospital, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Infections and organ transplantation: new challenges for prevention and treatment--a colloquium. Transplantation 2012; 93:S4-S39. [PMID: 22374265 DOI: 10.1097/tp.0b013e3182481347] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Anker AE, Feeley TH. Estimating the risks of acquiring a kidney abroad: a meta-analysis of complications following participation in transplant tourism. Clin Transplant 2012; 26:E232-41. [DOI: 10.1111/j.1399-0012.2012.01629.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Ashley E. Anker
- Department of Communication; University of Buffalo; The State University of New York; Buffalo; NY; USA
| | - Thomas H. Feeley
- Department of Communication; University of Buffalo; The State University of New York; Buffalo; NY; USA
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Spasovski G, Busic M, Raley L, Pipero P, Sarajlic L, Popovic AS, Dzhaleva T, Codreanu I, Ratkovic MM, Popescu I, Lausevic M, Avsec D, Ekberg H, Ploeg R, Delmonico F. Current status of transplantation and organ donation in the Balkans--could it be improved through the South-eastern Europe Health Network (SEEHN) initiative? Nephrol Dial Transplant 2012; 27:1319-1323. [DOI: 10.1093/ndt/gfs071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Akoh JA. Key issues in transplant tourism. World J Transplant 2012; 2:9-18. [PMID: 24175191 PMCID: PMC3812925 DOI: 10.5500/wjt.v2.i1.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/18/2011] [Accepted: 02/23/2012] [Indexed: 02/05/2023] Open
Abstract
Access to organ transplantation depends on national circumstances, and is partly determined by the cost of health care, availability of transplant services, the level of technical capacity and the availability of organs. Commercial transplantation is estimated to account for 5%-10% (3500-7000) of kidney transplants performed annually throughout the world. This review is to determine the state and outcome of renal transplantation associated with transplant tourism (TT) and the key challenges with such transplantation. The stakeholders of commercial transplantation include: patients on the waiting lists in developed countries or not on any list in developing countries; dialysis funding bodies; middlemen, hosting transplant centres; organ-exporting countries; and organ vendors. TT and commercial kidney transplants are associated with a high incidence of surgical complications, acute rejection and invasive infection which cause major morbidity and mortality. There are ethical and medical concerns regarding the management of recipients of organs from vendors. The growing demand for transplantation, the perceived failure of altruistic donation in providing enough organs has led to calls for a legalised market in organ procurement or regulated trial in incentives for donation. Developing transplant services worldwide has many benefits - improving results of transplantation as they would be performed legally, increasing the donor pool and making TT unnecessary. Meanwhile there is a need to re-examine intrinsic attitudes to TT bearing in mind the cultural and economic realities of globalisation. Perhaps the World Health Organization in conjunction with The Transplantation Society would set up a working party of stakeholders to study this matter in greater detail and make recommendations.
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Affiliation(s)
- Jacob A Akoh
- Jacob A Akoh, South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom
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McGill RL, Ko TY. Transplantation and the primary care physician. Adv Chronic Kidney Dis 2011; 18:433-8. [PMID: 22098662 DOI: 10.1053/j.ackd.2011.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 10/14/2011] [Accepted: 10/18/2011] [Indexed: 01/10/2023]
Abstract
Increasing appreciation of the survival benefits of kidney transplantation, compared with chronic dialysis, has resulted in more patients with kidney disease being referred and receiving organs. The evolving disparity between a rapidly increasing pool of candidates and a smaller pool of available donors has created new issues for the physicians who care for kidney patients and their potential living donors. This article outlines current efforts to address the growing number of patients who await transplantation, including relaxation of traditional donation criteria, maximization of living donation, and donation schemas that permit incompatible donor-recipient pairs to participate through paired donation and transplantation chains. New ethical issues faced by donors and recipients are discussed. Surgical advances that reduce the morbidity of donors are also described, as is the role of the primary physician in medical issues of both donors and recipients.
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Rogers BA, Aminzadeh Z, Hayashi Y, Paterson DL. Country-to-country transfer of patients and the risk of multi-resistant bacterial infection. Clin Infect Dis 2011; 53:49-56. [PMID: 21653302 DOI: 10.1093/cid/cir273] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Management of patients with a history of healthcare contact in multiple countries is now a reality for many clinicians. Leisure tourism, the burgeoning industry of medical tourism, military conflict, natural disasters, and changing patterns of human migration may all contribute to this emerging epidemiological trend. Such individuals may be both vectors and victims of healthcare-associated infection with multiresistant bacteria. Current literature describes intercountry transfer of multiresistant Acinetobacter spp and Klebsiella pneumoniae (including Klebsiella pneumoniae carbapenemase- and New Delhi metallo-β-lactamase-producing strains), methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and hypervirulent Clostridium difficile. Introduction of such organisms to new locations has led to their dissemination within hospitals. Healthcare institutions should have sound infection prevention strategies to mitigate the risk of dissemination of multiresistant organisms from patients who have been admitted to hospitals in other countries. Clinicians may also need to individualize empiric prescribing patterns to reflect the risk of multiresistant organisms in these patients.
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Affiliation(s)
- Benjamin A Rogers
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia.
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Abstract
Hepatitis E, usually an acute hepatitis in the immunocompetent, has a chronic form described in immunocompromised hosts. We report the clinical course and outcome of an adult liver transplant recipient whose posttransplant period was complicated by chronic hepatitis E, Epstein-Barr virus infection, and cellular rejection of the graft.
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