Commercial Kidney Transplant Increases Risk To Patients

But according to a report published in the current issue of the Medical Journal of Australia, these patients face an increased risk of infection (such as HIV and hepatitis B), other complications and death.

The report states that, while around 520 kidney transplants are performed in Australia each year, approximately 2,000 people are on waiting lists. Commercial transplantation is prohibited by legislation in Australia with most donations coming from deceased donors, or people who are genetically or emotionally related to the recipient.

Many countries, including India, Iraq, Iran, Eastern Europe, South America, South Africa and the Philippines have commercial kidney transplantation programs. China also has large commercial transplant programs, which attract recipients from around the world. The source of the kidneys is not always known with some reports claiming that up to 90 per cent of transplanted kidneys in China are retrieved from executed prisoners.

Bruce Pussell, Professor of Medicine at the Prince of Wales Hospital in Sydney, and colleagues, reviewed the literature about outcome of overseas commercial kidney transplantation and reported the experience of four Australian centres.

"Our centres have had 16 patients who have travelled overseas to receive a commercial kidney transplant and five have subsequently died," Professor Pussell said.

The authors only reported the outcomes of patients who returned from overseas after transplantation, which means that deaths and complications occurring before the patients returned home may have been underreported.

Of concern, the commercial transplant programs did not appear to screen donors for infectious diseases despite a generally high incidence of Cytomegalovirus, HIV, Hepatitis B and Hepatitis C in these countries.

"As physicians caring for patients with ESKD, we should be able to offer informed advice about commercial transplantation. Ethical reasons, in particular concerning the rights and well-being of donors, are enough to prevent us from recommending overseas commercial transplantation (in its current form) as a treatment for ESKD," Professor Pussell said.

"We suggest that patients considering commercial organ donation should be advised that heightened risks to life and graft survival exist. If they decide to proceed with commercial transplantation, they should specifically seek assurances about screening for HIV and viral hepatitis before departure. They should also be aware that a donor kidney may not be available and that haemodialysis overseas may further expose them to blood-borne viruses. All attempts should be made to ensure adequate documentation and communication," Professor Pussell said.

Commenting on the report in a linked editorial, Dr Timothy Mathew, medical director of Kidney Health Australia and colleagues said the shortage of kidneys for transplantation in Australia reflects our low deceased-donator rates, compared with the rates in other developed countries.

Positive moves are now being made to improve organ donation rates, which are much higher in some Australian states than others.

According to Dr Mathew, "If Australia's organ donation rate could match that of its best performing hospitals and states, the embarrassing situation driving dialysis patients to take the risks involved with travelling overseas for kidney transplantation would not exist. Much remains to be accomplished, but there are grounds for optimism in believing that Australia's deceased-donor organ donation rate could double if the barriers existing in the hospital system could be removed."

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT Professor Bruce PUSSELL 02 9382 2775 / 02 9382 2222

Dr Timothy MATHEW 0416 149 863

Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471