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Canadian ‘transplant tourists’ putting their lives at serious risk: study

National Post logo National Post 2016-04-16 Tom Blackwell
Ramesh-Prasad: File © File File

The steady stream of Canadians who continue to buy organs overseas are not only propping up a morally dubious trade, but putting their own lives at serious, long-term risk, suggests a new study.

One of the lead authors says the findings offer more reason why the federal government should make participating in transplant tourism a criminal offence.

People who obtained a kidney transplant outside Canada, then returned for after-care at a Toronto hospital, were three to four times as likely to die or lose the organ as those transplanted here, the researchers found.

And they brought home some nasty souvenirs, including potentially deadly cases of hepatitis and tuberculosis, says the study.

It’s believed Canadians seek out transplants overseas because of long wait lists here and the fear of dying before a donor becomes available. Kidneys are by far the most commonly transplanted organ.

Previous research has highlighted the poor short-term results of commercial kidney grafts abroad. But the study by doctors at St. Michael’s Hospital in Toronto appears to be the first to show that patients who survive the initial months continue to fare badly, as long as eight years after buying their organ.

Patients never express any kind of regret for having done what they did, even when they’re very sick.

The blame likely goes to poor surgical techniques, infection and inadequate matching with the donor at the time of the original operation, experts say.

Such information should be used to deter Canadians from participating in the commercial organ business, says the paper in the journal Kidney International.

Despite some progress in curbing the trade, three to five people a year still show up just at St. Michael’s having obtained a kidney in places like China, Pakistan or India, says Dr. Ramesh Prasad, a nephrologist who spearheaded the study.

It would be a major step forward if the government actually banned the practice, he said.

“If patients are told it’s a crime, that might curtail people going abroad,” said Prasad. “It’s definitely frustrating. Patients never express any kind of regret for having done what they did, even when they’re very sick.… They’re so convinced they did the right thing for themselves.”

Still, St. Michael’s will always provide treatment without question to returning transplant tourists, he said, though they sometimes need more aggressive care and infection-control procedures.

St. Paul’s Hospital, one of two in Vancouver that conducts kidney transplants, also sees three to five returning organ tourists annually, says Dr. Jag Gill, a transplant nephrologist there.

If the St. Paul’s team has seen such a recipient previously and advised against going overseas, they sometimes transfer the person to another transplant centre, he said.

“We have in the past said, ‘Our relationship with that patient is tarnished,’ ” said Gill. “That creates a bit of an awkward situation, and the last thing you want to do is compromise patient care because of hard feelings between the doctor and patient.”

The trade in organ transplants has been widely condemned, evidence indicating that donors are at best poorly compensated and treated, at worst kidnapped and their organs harvested involuntarily. In China, a destination for some Canadian patients, it’s believed organs are often taken from executed prisoners.

A study by St. Michael’s 10 years ago — and research elsewhere — has indicated that the outcomes for patients who got their organs on the black market abroad were worse in the first couple of years after the transplant.

But the most recent study looked at 69 returning patients over a longer, eight-year period, and found they continued to experience loss of the organ and death at higher rates than domestic recipients.

About 20 per cent of the commercial-transplant patients had died by the end of eight years, and about 30 per cent had lost their purchased kidneys — three to four times higher than among domestic recipients, the study found.

Gill said the experience in Vancouver appears to be similar.

Having an organ fail and needing another one puts patients in a worse position, since finding a match a second time is more difficult and complicated, Prasad said.

While many patients do die while waiting for organs here, the queues are getting shorter, he said.

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