Medical Tourism

Medical tourism is the practice of cross country traveling, with the destination usually being India or China, of patients in need of an organ. Patients travel to these countries because wait times are minimal or they have been unsuccessful in their home country to find a match. On the surface this may not seem such a bad practice. A person in need of a life saving transplant is able to obtain an organ without having to wait on the organ transplant list. But what is the cost of a short waiting list? The cost is these organs are obtained from the poor. Organs are being harvested and donors paid minimal amounts or these organs are being harvested from executed prisoners as discussed in the previous blog. The focus of these blog is primarily on India and their practice of victimizing the poor.  

According to Labonte et al (2010), when using the internet search terms of; hospital, international patients and medical tourism contact information for thirty-one hospitals in India and twenty-nine hospitals in China were discovered. Questionnaires for these hospitals were in English, Arabic, French, Chinese Russian and German. When I have visited a hospital the forms are either in English or Spanish which is due English being the native language and Spanish being the language spoken by a large portion of those living in America. It is hard to believe there is a large population of a person of French or Russian decent living in India. India is catering to medical tourist at the expense of their poor. India has the largest proportion of medical travelers coming from the USA, Canada and Britain. India has more medical tourist than China, Jordan and the United Arab Emirates combined. (Labonte et al 2010). Why is it that India has more medical tourism then China, Jordan and the United Arab Emirates combined? India makes it extremely easy for the medical tourist to enter the country, so easy that they even have a special medical visa which is valid for the duration of the medical treatment. In all of countries a person must apply for a visitor visa and if they extend their stay they must keep renewing the visa. (Labonte et al 2010).

According to Anuj (2008), Organ hunters will visit the slums of India promising those living in poverty if they donate an organ they will become rich. They promise the patients on average $2500 for a kidney, sometimes three times that much. After the organ has been butchered out of the donor they are usually given only half of the original $2500 and left with a lifetime of pain from a botched surgery. A kidney recipient will pay on average $25,000 for the surgery. With only $1250 going to the donor, the doctors and organ hunters obtain a large profit. Often times the donor is placed into further debt because they are likely to miss work from the chronic pain. Medical tourism is only going to continue to grow in India. In 2005 150,000 patients were treated in India. By 2012 medical tourism in India is likely to generate two billion US dollars (Labonte et al 2010).

According to American.edu, with pressure from the west India passed The Transplantation of Human Organs Act which only allowed for immediate relatives to donate an organ or if the donor had suffered a brain-stem death. This act is ineffective because it is up to each individual state to enforce legislation and only three (Maharashtra, Goa, and Himachal Pradesh) have actually enforced the law.  With no agreement between the federal and state level it is unlikely there will be any change in the foreseeable future. According to American.edu, selling an organ is only punishable by up to seven years incarceration and $300 fine. Just because the crime is punishable by up to seven years does not mean a person will actually be sentenced to such a term. One kidney can receive up to $25,000. If a person is only being fined $300 that really not much of an incentive to stop when greed is associated.  To make maters even worse organ selling is only punishable in the three states that have adopted the The Transplantation of Human Organs Act. Those who practice organ harvesting know they just need to operate anywhere else in the country except for the three states of Maharashtra, Goa, and Himachal Pradesh.

            While researching this blog some have argued that in order to decrease the number of people victimized by organ harvesting the government needs to allow for the selling of human organs. With the government running the program it will stop the black market that has been created and leave the poor to not being victimized. While this sounds good in theory, protect the poor from the rich, it is unethical. A person living in poverty should not have to sell a part of them to afford to feed their families. Hearing the story of people who had agreed to have a kidney donated only to have been butchered and left with chronic pain is shameful. The government of India needs to look at how to change their countries social situation so they do not have citizens who are even contemplating selling an organ to provide for their family. Instead of protecting the poor from the rich, protect the poor from poverty.

Chopra, Anuj.(2008)  "Harvesting Kidneys From the Poor for Rich Patients." U.S. News & World Report 144.5: 33-34.

Labonte, Ronald & Zuxun Lu & Mohd Jamal Alsharif (2010) ‘Patients Beyond Borders: A Study of Medical Toursists in Four Countries.’ Global Social Policy 10/315

TED Case Studies India Kidney Trade, May 02, 2011 from http://www1.american.edu/TED/KIDNEY.HTM

China's Inhumane Organ Procurement Practice

China leads the world in less than ethical organ procurement. China is dependent upon the execution of prisoners to support their booming organ donation business. According to Biggens et al 2009, 95% of the organ donors in China are executed prisoners.

The Chinese government has released several documents concerning the use of executed prisoners as organ donors. According to Lenning (2007), in 1979 China published Rules Concerning the Dissection of Corpses. This was the first documentation by the Chinese government confirming the uses of organ donation from executed prisoners. China has some of the harshest penalties in the world. An act of theft can constitute capital punishment. (American.edu) In 1984 China passed Rules Concerning the Utilization of Corpses or Organs for the Corpses of Executed Prisoners. This allowed for organs of executed prisoners to be harvested if the body was not claimed by a family member, if the family has given consent, or if the prisoner volunteered to donate. (American.edu) One prisoner serving a seven year sentence witnessed, on several different occasions, prisoners who were having blood samples taken and being medically screened for organ donation the night before their execution. (American.edu) The proclamation On the Use of Dead bodies or Organs from Condemned Criminals states theuse of organs from condemned criminals should be strictly confidential, there is no time frame specified that a family must claim the body, after organ procurement the deceased is to be cremated and the family members may then pick up the ashes. (Lenning 2007). With the laws governing organ procurement being so vague it is unlikely that a family would even know if their loved one had been an organ donor. There is no required time frame that a body is officially unclaimed. If the government wishes, they could begin organ procurement shortly after execution, cremate the remains and the family is none the wiser.

Documentation from the Chinese government shows that between 2,000 to 3,000 human organs, from approximately 4,500 executed prisoners, are procured each year. Through the 1990’s China executed more people than the rest of the world combined. (American.edu) At a rate of 4500 executed prisoners a year, it is not surprising that China surpasses all other countries in executions.

Why does the Chinese government allow for such lax organ donation standards? Organ donation is big money. A liver can sell for $25,000, a kidney for $20,000 and corneas and pancreases for $5,000 a pair. (American.edu) With 2,000 to 3,000 human organs being harvested a year, China is gaining millions of dollars in profit. Since the Chinese government is not putting a stop to the unethical organ procurement procedures why has there not been an international movement to stop China? According to American.edu, there are no international laws which can be enforced upon the Chinese government and no organization that can make the Chinese government comply with international human rights decree. Since there is not an international law and no agency which can enforce an investigation into the Chinese process of organ donation there is no way to force the Chinese government into compliance.

It is interesting that China has such a high rate of organ transplantation when such a thing is taboo in Chinese culture. Buddhism and Confucianism dominate the nation’s religious values. ‘Chinese religious traditions dictate that bodies are to be kept whole after death, meaning voluntary donations are rare, if they occur at all. Chinese are so dedicated to this notion of keeping dead bodies intact that the autopsy rate is virtually zero.’(Lenning 2007) Wang et al (2010) argues that ‘an important Confucian requirement that one should protect one’s body and attempt not to damage it because one’s body, from the Confucian view, is received from one’s parents and ancestors to whom one should keep filial. Wang et al (2010) has mentioned that inmates in the past were coerced to donate their organs by being treated better while in prison. Another explanation for China’s high rate of organ donation is that according to American.edu, the family is responsible to compensate the government for the cost of incarceration, the bullet used to kill the offender as well as cremation costs. It is unlikely that a family can afford neither these fees nor wanting the shame of having a family member in prison. It is becomes unlikely a family member will claim the body which leaves the Chinese government ‘legally’ allowed to procure the organs.

What can be done? International law needs to be created that creates regulations on organ donation. There must be an agency which investigates and enforces policy.

Biggins, S. W., Bambha, K., Terrault, N., Inadomi, J., Roberts, J. P., & Bass, N. (2009). Transplant tourism to China: the impact on domestic patient-care decisions. Clinical Transplantation, 23(6), 831-838.

Lenning, Emily. "Execution for Body Parts: A Case of State Crime." Contemporary Justice Review 10.2 (2007): 173-191. Academic Search Premier. EBSCO. Web. 3 May 2011.

Wang, M., & Wang, X. (2010). Organ Donation by Capital Prisoners in China: Reflections in Confucian Ethics. Journal of Medicine & Philosophy, 35(2), 197-212. doi:10.1093/jmp/jhq008

Illegal Human Organ Trade from Executed Prisoners in China, May 03, 2011 from, http://www1.american.edu/ted/prisonorgans.htm

Blood Donation ... Homophobic Practice or Protecting Society????

I last donated blood during a blood drive at work. My coworker, who was a homosexual male in a monogamous relationship, was unable to donate because he was at higher risk for having contracted HIV. This had me curious if the screening of blood donors was homophobic?

According to cdc.gov homosexual males are at a higher risk of contracting HIV then non-homosexuals.  What about other categories such as state, age and race? New York has the highest rate of new infections in 2009. A person between the ages of 20-24 has the highest risk of contracting HIV. While the fastest growing rate of new HIV infections is in the African-American community. If you look at the numbers why is it that a man who has had contact with another man cannot donate blood but state, age and race are not factors which will exclude a person?

According to cdc.gov in 2009 there were 23,846 diagnoses of HIV infections through male-to-male sexual contact. In 2009, 21,652 African-Americans were diagnosed with HIV. Why is a persons sexual orientation being discriminated against but not a race when the number of new diagnosed are almost the same? Simple, because it would be wrong to discriminate against a persons race. Why then is it ok to discriminate against a sexual orientation? To be fair should no one who is a homosexual male, live in New York, is African-American or between the ages of 20-24 not be able to donate?

Instead of the practice of approved discrimination against homosexuality why not change the screening process? In 2003 the risk of contracting HIV from a blood transfusion was between 1 in 1.4 million and 1 in 1.8 million, hivinsite.ucsf.edu. Is this a result of a better screening process of donors or testing the blood for HIV anti-bodies? Almost all cases of HIV infection resulting from blood transfusion were before 1985 when testing for HIV antibody was not available to screen donated blood. (hivinsite.ucsf.edu)

Detectable HIV antibodies develop within 6 to 12 weeks of infection. (avert.org). Instead of discriminating against a complete category of people and expedite the medical process of blood donation ask two questions of all potential donors; In the last 12 weeks have you had any unprotected sexual encounters outside of a mutually monogamous relationship? If in a mutually monogamous relationship have you been in this relationship longer then 12 weeks. If the answer is yes to the first question and no to the second question the person should be disqualified for 12 weeks which is the time frame the HIV antibody would take to be detectable.  If the person answers no to the first question and yes to the second question the risk of HIV infection is very little.  If they are infected the HIV antibody would be detectable through screening of the blood.

The Different Types of HIV Testing,  April 03, 2011 from,

 http://www.avert.org/testing.htm

Transmission of HIV by Blood, Blood Products, Tissue Transplantation, and Artificial Insemination, April 02, 2011 from 

http://hivinsite.ucsf.edu/InSite?page=kb-07-02-09#S2.2X

Basic Statistics, April 03, 2011 from,

http://www.cdc.gov/hiv/topics/surveillance/basic.htm#hivaidsage

Stem Cell Research

Stem cell research the future cure for organ failure or a moral wrong of society?

   What exactly is stem cell research? ‘Stem cells, which have the ability to adapt and regenerate into different cell types in the body, have the potential to replace tissues damaged by disease’. (isscr.org) Science is just beginning to exam the full potential of human embryonic stem cells which has the potential to someday cure Parkinson’s disease, Alzheimer’s, spinal cord injury, cancer and organ failure. Stem cell research can eliminate the need for many transplants and possibly lead to the creation of a new organ which is the genetic equivalent of the original (kidney.org). A patient who receives an organ transplant is dependent on anti-rejection medicine, immunosuppressive medications, for the rest of their life. These medications weaken a patients’ immune system so that it will not reject the transplanted organ but it also makes the patient more susceptible to other illnesses. If stem cells are used to either repair an organ damaged by disease or create a new one immunosuppressive medications would no longer be needed. Does the end justify the means? (isscr.gov)

   According to washingtonpost.com, the first veto issued by former President George W. Bush was rejecting Congress’s bid to lift funding restrictions on human embryonic stem cell research. In 5 ½ years in office this was the first veto he issued. This veto was issued a little over a month after I donated a kidney to my sister. I remember asking my sister if President Bush would have issued that veto if it was him and his brother in place of my sister and I? During his speech about why he vetoed the bill he had children in the background who were adopted embryos. Adopted embryos result from couples who have gone through fertility treatment and have had the number of children desired. Not wanting to destroy the unused embryo they allow another couple to adopt the embryo. Of the 400,000 frozen embryos stored in U.S. fertility clinics the majority are waiting disposal because the couples who created them completed their pursuit for a child and do not want someone else raising their biological child. Of those 400,000 embryos only 128 will become an adopted embryo (washingtonpost.com). If these embryos are only going to be disposed and the couple would like to donate them to research then why not let them? 

   Former President Bush and many religious people are against stem cell research because of the ‘moral’ wrong. According to the catholic faith human life is created when a mans sperm fertilizes a woman’s egg. When is a baby viable? A baby is viable when it can survive outside the mother’s womb. An 8-week old embryo can not survive outside the womb. According the americancatholic.org, ‘The same ethic that justifies taking some lives to help the patient with Parkinson's or Alzheimer's disease today can be used to sacrifice that very patient tomorrow.’ Honestly what would be the purpose of curing Parkinson and Alzheimer’s disease just to kill that same person? Americancatholic.org also stated how stem cell research will lead to ‘cloned embryos in a woman's womb in order to harvest tissues and organs from them.’ This will not happen because embryonic stem cell research and therapy would use donated embryos that, by virtue of donor instructions, will never enter a uterus. (isscr.gov)

   Fortunately for those who would benefit from stem cell research President Barack Obama lifted funding restrictions on human embryonic steam cell research.

  According to Brodie et al (2005) a patient who is on dialysis in their early 20’s can expect the same remaining lifespan as a 70-year-old. If that patient were to receive a transplant they can expect to have the same remaining lifespan as a 40-year-old. Kidney failure can result in a 20-year-old to lose anywhere from 20-50 years of life. Those against stem cell research are arguing for the morality of the life of the embryo but what about the morality of those suffering from kidney failure. A person who is against stem cell research of human embryonic cells is saying the life of the person who is already living, breathing and fighting for life is less important than the retrieval of stem cells from a human embryo that never would have been carried to term.  So ask yourself does the end justify the means?

Brodie, James C and Humes, David H. (2005) ‘Stem Cell Approaches for the Treatment   of Renal Failure.” Pharmacological Reviews, 57/3. 299-313.

Do Stem Cells Hold the Key for the Future of Transplantation, February 23, 2011 from, 

http://www.kidney.org/news/newsroom/fs_new/stemcellskey.cfm

Embryonic Stem-cell Research, Unnecessary, Bishops Says, February 23, 2011 from,

http://www.americancatholic.org/news/stemcell/

The Ethics of Human Embryonic Stem Cell Research, February 23, 2011 from,

http://www.isscr.org/public/ethics.htm

Glossary at a Glance, February 23, 2011 from,

http://www.kidney.org/news/newsroom/fs_new/gloss@glance.cfm

Stem Cell Bill Gets Bush’s First Veto, (2006) February 23, 2011 from,

http://www.washingtonpost.com/wp-dyn/content/article/2006/07/19/AR2006071900524.html

Organ Donation Affects Everyone

       109, 719 people are waiting for an organ. 18 people will die each day waiting. 1 organ donor can save up to 18 lives. One person can; free two people from dialysis, save the lives of patients needing a new heart, liver, lung or pancreas, give back two peoples vision and help a burn victim heal with the donation of skin (organdonor.gov). In the event of a tragedy it would be nice to know you could make a difference to so many lives. After all once a person passes away clearly they are not using their organs anymore; why not give the gift of life? 

      You may be asking yourself how this affects you. It affects you in regards to where your tax dollars are being spent. Instead of education, lowering unemployment or drug abuse counseling your tax dollars are being used to treat patients waiting for an organ donation. Chronic Kidney Disease (CKD) cost Medicare $70 billion annually. No longer needing to be on dialysis, one kidney transplant could save $288,000. (medicare-medicaid.com). How else does organ donation affect you? Every 11 minutes another name is added to the transplant waiting list (organdonor.gov). It could be you, a loved one or a friend. 

    The transplant waiting list has doubled in the last 10 years. (health.discovery.com) With the waiting list doubling if the number of people registering as an organ donor does not increase the waiting time is going to increase. Fortunately a person waiting for a kidney has dialysis to sustain life and lead a semi ‘normal’ life but what choice does a person waiting for a new heart or liver have? Their choice is live life in a hospital bed waiting for that life saving organ which may not come in time. Depending on the organ, a person can wait on average 113 to 1,219 days (organdonor.gov)

    It is important to speak to your family about your wishes. Even if you have registered as a donor in some states, California included, if your family does not give consent your organs will not be retrieved. The video below shows an example of such a scenario.

   As a living donor myself I know firsthand the wonderful feeling of donating. While it was a difficult decision at first, I later came to realize my sister’s health was more important than my fear of surgery. Being a donor has even lead to a healthier lifestyle. To donate I needed to lose 50lbs. Pre-transplant I was at risk of diabetes due to being overweight. Now my risk of diabetes has decreased. I now make sure to eat healthier, exercise and drink less alcohol knowing that I need to take care of myself. The surgery and recovery was painful but seeing my sister healthy and now married with a baby on the way made the transplant worth every bit of pain.

Facts and Figures About Organ Donation (2011) February 9, 2011 from,
http://health.discovery.com/convergence/giftoflife/facts/facts.html

Kidney Patients - Better Care at Less Cost, (2009) February 9, 2011 from,
http://medicare-medicaid.com/index.php?s=dialysis 

Organ Transplantation: The Process (2011) February 9, 2011 from,
http://organdonor.gov/organTransplantationProcess.asp#process1 

The Need is Real: Data (2011) February 9, 2011 from,
http://organdonor.gov/aboutStatsFacts.asp