Examiner.com posted “Transplant tourism and patient safety” by Kristin Eckland.
In previous articles, the author has written about medical tourism in Mexicali, Mexico including several stories about the surgeons providing excellent service to medical tourists. In this two part series, the author explores the shadier side of medical tourism: transplant tourism.
In the wake of a disturbing article by Dan Bilefsky from the New York Times on the economic desperation in parts of Europe leading to the selling of organs, I would like to offer my own personal perspectives and narratives on the murky world of transplant tourism. Even if we ignore the ethical implications of the victimization and exploitation of the world’s poor serving as ‘spare parts’ for the wealthy, the safety and medical implications of this growing practice are impossible to overlook.
Medical risks of transplant tourism
In transplant tourism, there are two potential victims; the donor and the recipient. The recipient is at equal risk of victimization in their pursuit of health and life; as unscrupulous brokers often sell services that facilities are not equipped to provide. Here, in the medical industry, we call it ‘selling hope’.
Selling Hope
“So why are all the records from 2007?” my professor asks. If the patient is sick enough to need a lung transplant, then he is probably in to see his doctors at least once a month, maybe more often. It’s just one of the questions for a situation that doesn’t really make sense. There’s no echocardiogram, there’s nothing in the chart to even indicate if this patient needs one lung or two or even a heart-lung transplant.
The players are big names; in this case, Planet Hospital is involved as the broker, but the story still doesn’t make sense, until you factor in the money. He doesn’t really want to be involved, but the pressure is coming from all sides, and the professor can’t stop himself from asking.
The patient is from Europe, which tells us a couple of things; one is that he’s very, very desperate, and that he must have been turned down by ever other respectable, and not-so-respectable program around, meaning he’s not a suitable candidate. “And why does he want to come to Mexicali?” my professor asks, feigning ignorance. The voice at the other end of the speakerphone keeps playing the game, saying, “oh, well, he likes Mexico,” he replies before later conceding that the situation is exactly what we’d assumed.
No qualified surgeon is not an obstacle
It was easy enough to see thru the charade; if you know anything about Mexicali, and the state of healthcare here in the capital of Baja, California. While it is certainly a suitable location for a quick nip and tuck, there are no facilities equipped to manage something of this magnitude. In fact, there are just a few lung transplant surgeons in all of Mexico, none of whom lives remotely close to here, which is why they approached the professor.
My professor has the surgeon from Mexico City on speakerphone because he wants to get my opinion of the situation, which he finds so implausible that he’s having difficulty believing the realities of it. It is incredible to consider that there is a company willing to risk this patient’s life as a part of doing business. But then, later in the discussion, he starts asking the hardball questions under the pretense of friendly banter with an old colleague. “So what’s the gana here?” he asks, wanting to know the financial payout.
Huge financial incentives
He laughs out loud when the other surgeon mentions a price that is ridiculously low. Quickly after, the real money involved emerges, 3 million Mexican pesos for the transplant, and that’s just the costs we know about. We have no idea what Planet Hospital is actually charging the patient; it’s probably much, much more. But then again; what they are selling is priceless: the illusion of hope. In a country where the average surgeon earns just 300,000 pesos (or less than 20,000 dollars) a year, the attractiveness of the offer is enough to make any surgeon, no matter how ethical, pause.
The decision
We have between us, the doctor and I; a trust of sorts built from my previous work here in Mexicali. I trust that he won’t become involved in this horrible miscarriage of medicine, and he trusts me to always tell the truth about medicine and surgery here in Mexico. I trust him because despite limited resources, and adverse conditions, he is an excellent surgeon; talented in the operating room, impeccable clinical judgment, a love for his profession and caring and compassionate to his patients. It’s an unbeatable mix, and it’s what brought me back to Mexicali to study with him after completing several interviews with the doctor as part of a separate project.
He trusts me, I think because of my willingness to state the truth, no matter what. I am willing to talk about excellence in a sea of mediocrity, but I am equally quick to point out problems and serious issues at the same time. In fact, I had recently done that when writing an article about a close colleague of his. At the time, I had expected censure from the doctor but was prepared to stand firm; instead I received renewed respect. I think he understands even better than I the long-term ramifications of candy-coating the situation.
After all, I will go home, and move on to the next location at the end of summer. He will live in Mexicali for the rest of his life. If patients suffer or even die because of rosy-colored articles on medical care here, his practice will suffer, even if he wasn’t the one operating.
But now, we are both uncomfortable with the situation, and unable to let it lie. Eventually, talk of the transplant patient coming to Mexicali fades away, but it leaves disturbing implications.
In our next article we will talk about the specifics of this case, and brokers offering lung transplantation.