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Transplant Tourism: Understanding the Risks

  • Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

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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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kotton CN. Transplant tourism and donor-derived parasitic infections. Transplant Proc. 2011;43(6):2448–9.

    Article  CAS  PubMed  Google Scholar 

  2. Merion RM, Barnes AD, Lin M, Ashby VB, McBride V, Ortiz-Rios E, et al. Transplants in foreign countries among patients removed from the US transplant waiting list. Am J Transplant. 2008;8(2):988–96.

    Article  CAS  PubMed  Google Scholar 

  3. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism: Transplantation. 2008; 86(8):1013–1018.

  4. Kennedy SE, Shen Y, Charlesworth JA, Mackie JD, Mahony JD, Kelly JJP, et al. Outcome of overseas commercial kidney transplantation: an Australian perspective. Med J Aust. 2005;182(5):224–7.

    PubMed  Google Scholar 

  5. Vathsala A. Outcomes for kidney transplants at the National University Health System: comparison with overseas transplants. Clin Transpl. 2010;149–160.

  6. Sajjad I, Baines LS, Patel P, Salifu MO, Jindal RM. Commercialization of kidney transplants: a systematic review of outcomes in recipients and donors. Am J Nephrol. 2008;28(5):744–54.

    Article  PubMed  Google Scholar 

  7. Kotton CN, Hibberd PL. The AST Infectious diseases community of practice. Travel medicine and transplant tourism in solid organ transplantation. Am J Transplant. 2013;13(4):337–47. Guidelines from the AST Infectious Diseases Community of Practice regarding prevention of vaccine and nonvaccine preventable illnesses in solid organ transplantation travelers, including recommendations for the management of patients returning after transplantation abroad.

    Article  CAS  PubMed  Google Scholar 

  8. Sack K. Transplant Brokers in Israel Lure Desperate Kidney Patients to Costa Rica. N Y Times [Internet]. 2014 [cited 2014 Dec 9]; Available from: http://www.nytimes.com/2014/08/17/world/middleeast/transplant-brokers-in-israel-lure-desperate-kidney-patients-to-costa-rica.html

  9. Chugh KS, Jha V. Commerce in transplantation in third world countries. Kidney Int. 1996;49(5):1181–6.

    Article  CAS  PubMed  Google Scholar 

  10. WHO | WHO proposes global agenda on transplantation [Internet]. 2007 [cited 2014 Dec 12]. Available from: http://www.who.int/mediacentre/news/releases/2007/pr12/en/

  11. Gill J, Madhira BR, Gjertson D, Lipshutz G, Cecka JM, Pham P-T, et al. Transplant tourism in the United States: a single-center experience. Clin J Am Soc Nephrol. 2008;3(6):1820–8.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Canales MT, Kasiske BL, Rosenberg ME. Transplant tourism: outcomes of United States residents who undergo kidney transplantation overseas. Transplantation. 2006;82(12):1658–61.

    Article  PubMed  Google Scholar 

  13. Polcari AJ, Hugen CM, Farooq AV, Holt DR, Hou SH, Milner JE. Transplant tourism—a dangerous journey? Clin Transpl. 2011;25(4):633–7.

    Article  Google Scholar 

  14. Odedra A, Green ST, Bazaz R. United Kingdom and republic of Ireland renal physicians’ experiences of patients undergoing renal transplants abroad: a questionnaire-based cross-sectional survey. Travel Med Infect Dis. 2014;12(6):702–6.

    Article  PubMed  Google Scholar 

  15. Naqvi S a A, Rizvi S a H, Zafar MN, Ahmed E, Ali B, Mehmood K, et al. Health status and renal function evaluation of kidney vendors: a report from Pakistan. Am J Transplant. 2008;8(7):1444–50.

    Article  CAS  PubMed  Google Scholar 

  16. Prasad GVR, Shukla A, Huang M, D''A Honey RJ, Zaltzman JS. Outcomes of commercial renal transplantation: a Canadian experience. Transplantation. 2006;82(9):1130–5.

    Article  PubMed  Google Scholar 

  17. Gomez CA, Singh N. Donor-derived filamentous fungal infections in solid organ transplant recipients. Curr Opin Infect Dis. 2013;26(4):309–16.

    Article  PubMed  Google Scholar 

  18. Chen LH, Wilson ME. The globalization of healthcare: implications of medical tourism for the infectious disease clinician. Clin Infect Dis. 2013;57(12):1752–9. An excellent review of the infections associated with medical tourism, including transplant tourism.

    Article  PubMed  Google Scholar 

  19. Cha R-H, Kim YC, Oh YJ, Lee JH, Seong EY, Kim DK, et al. Long-term outcomes of kidney allografts obtained by transplant tourism: observations from a single center in Korea. Nephrology. 2011;16(7):672–9.

    PubMed  Google Scholar 

  20. Sever MŞ, Kazancioğlu R, Yildiz A, Türkmen A, Ecder T, Kayacan SM, et al. Outcome of living unrelated (commercial) renal transplantation. Kidney Int. 2001;60(4):1477–83.

    Article  CAS  PubMed  Google Scholar 

  21. 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(3):E232–41. A meta-analysis of 19 studies analyzing the infectious and non-infections complications of transplant tourism.

    Article  PubMed  Google Scholar 

  22. Colakolgu M, Yenicesu M, Akpolat T, Vural A, Utas C, Arinsoy T, et al. Nonrelated living-donor kidney transplantation: medical and ethical aspects. Nephron. 1998;79(4):447–51.

    Article  Google Scholar 

  23. Sever M, Ecder T, Aydin AE, Türkmen A, KillÇaslan I, Uysal V, et al. Living unrelated (paid) kidney transplantation in third-world countries: high risk of complications besides the ethical problem. Nephrol Dial Transplant. 1994;9(4):350–4.

    CAS  PubMed  Google Scholar 

  24. Tsai M-K, Yang C-Y, Lee C-Y, Yeh C-C, Hu R-H, Lee P-H. De novo malignancy is associated with renal transplant tourism. Kidney Int. 2011;79(8):908–13.

    Article  PubMed  Google Scholar 

  25. Prabhakar KS, Vathsala A, Woo KT. Long-term outcome of living-unrelated donor kidney transplantation. Transplant Proc. 2000;32(7):1807–8.

    Article  CAS  PubMed  Google Scholar 

  26. Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–41.

    Article  PubMed  Google Scholar 

  27. Hauri AM, Armstrong GL, Hutin YJF. The global burden of disease attributable to contaminated injections given in health care settings. Int J STD AIDS. 2004;15(1):7–16.

    Article  PubMed  Google Scholar 

  28. Martín-Dávila P, Fortún J, López-Vélez R, Norman F, de Oca MM, Zamarrón P, et al. Transmission of tropical and geographically restricted infections during solid-organ transplantation. Clin Microbiol Rev. 2008;21(1):60–96.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010;10(9):597–602.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Harling R, Turbitt D, Millar M, Ushiro-Lumb I, Lacey S, Xavier G, et al. Passage from India: an outbreak of hepatitis B linked to a patient who acquired infection from health care overseas. Public Health. 2007;121(10):734–41.

    Article  PubMed  Google Scholar 

  31. Onwubalili JK, Obineche EN, Assuhaimi S, Bassiouni M. Outcome of bought living non-related donor kidneys followed up at a single centre. Transpl Int. 1994;7(1):27–32.

    Article  CAS  PubMed  Google Scholar 

  32. Alkhunaizi AM, Amir AA, Al-Tawfiq JA. Invasive fungal infections in living unrelated renal transplantation. Transplant Proc. 2005;37(7):3034–7.

    Article  CAS  PubMed  Google Scholar 

  33. Stas KJ, Louwagie PG, Van Damme BJ, Coosemans W, Waer M, Vanrenterghem YF. Isolated zygomycosis in a bought living unrelated kidney transplant. Transpl Int. 1996;9(6):600–2.

    Article  CAS  PubMed  Google Scholar 

  34. Shoham S, Hinestrosa F, Moore J, O’Donnell S, Ruiz M, Light J. Invasive filamentous fungal infections associated with renal transplant tourism. Transpl Infect Dis. 2010;12(4):371–4.

    Article  CAS  PubMed  Google Scholar 

  35. Fadhil RAS, Al-Thani H, Al-Maslamani Y, Ali O. Trichosporon fungal Arteritis causing rupture of vascular Anastamosis after commercial kidney transplantation: a case report and review of literature. Transplant Proc. 2011;43(2):657–9.

    Article  CAS  PubMed  Google Scholar 

  36. Nalmas S, Bishburg E, Goldstein C. Mucormycosis in a transplanted kidney. Transpl Infect Dis. 2008;10(4):269–71.

    Article  CAS  PubMed  Google Scholar 

  37. Mitwalli A, Malik GH, Al-Wakeel J, Aisha HA, Al-Mohaya S, Al-Jaser A, et al. Mucormycosis of the graft in a renal transplant recipient. Nephrol Dial Transplant. 1994;9(6):718–20.

    CAS  PubMed  Google Scholar 

  38. Chkhotua A, Yussim A, Sobolev V, Bar-Nathan N, Shaharabani E, Shapir Z, et al. Mucormycosis of the renal allograft: case report and review of the literature. Transpl Int. 2001;14(6):438–41.

    Article  CAS  PubMed  Google Scholar 

  39. Geddes CC, Henderson A, Mackenzie P, Rodger SC. Outcome of patients from the west of Scotland traveling to Pakistan for living donor kidney transplants. Transplantation. 2008;86(8):1143–5.

    Article  PubMed  Google Scholar 

  40. Hung CC, Chang SC, Chen YC, Yen TS, Hsieh WC. Plasmodium vivax infection in a renal transplant recipient: report of a case. J Formos Med Assoc. 1994;93(10):888–9.

    CAS  PubMed  Google Scholar 

  41. Türkmen A, Sever MS, Ecder T, Yildiz A, Aydin AE, Erkoç R, et al. Posttransplant malaria. Transplantation. 1996;62(10):1521–3.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Ban Hock Tan for his assistance. Dr. Chin-Hong is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Numbers UL1 TR000004 and TL1 TR000144. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Conflict of Interest

Jennifer Babik and Peter Chin-Hong have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143, USA

    Jennifer M. Babik & Peter Chin-Hong

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  1. Jennifer M. Babik
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  2. Peter Chin-Hong
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Correspondence to Jennifer M. Babik.

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This article is part of the Topical Collection on Transplant and Oncology

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Babik, J.M., Chin-Hong, P. Transplant Tourism: Understanding the Risks. Curr Infect Dis Rep 17, 18 (2015). https://doi.org/10.1007/s11908-015-0473-x

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  • DOI: https://doi.org/10.1007/s11908-015-0473-x

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