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July 25, 2006 (Boston) -- Traveling overseas for a transplant carries a host of problems, not the least of which are long-term complications that can kill, a new study suggests.
With the number of Americans with failing kidneys waiting for new organs now topping 70,000, more and more are choosing "tourism" transplants.
Doctors who followed 10 people who flew from the U.S. to the Middle East and Asia in search of a new kidney say that the transplanted organs generally worked well. But four of the 10 developed serious infections. One died.
"The new kidneys functioned well," says researcher Muna T. Canales, MD, who specializes in kidney diseasekidney disease at the University of Minnesota in Minneapolis. "But there was a high risk of complications that could be deadly -- and in one case, was."
Canales presented the new research here at World Transplant Congress 2006.
Dialysis Propels Many Overseas
Canales says that there's no information on how many people are going overseas in search of a new kidney, liver, lung, or other organ, "though we know it's going up." Nor are there reliable data on how these people fare.
Of the 10 people she followed, eight traveled to Pakistan for their new kidney. One went to Iran, and the other flew to China. In all but once case, they received their new lease on life from a live donor. About one in three kidney transplants performed in the U.S. involve live donors.
In addition to having failing kidneys, the transplant "tourists" suffered from a variety of ailments before the procedure ? such as high blood pressurehigh blood pressure and diabetesdiabetes. But the chief complaint that led to their decision to hop a jet was that they didn't want to stay on dialysis.
Nine of the 10 had been undergoing dialysis for an average of 1.5 years, Canales says. "You have to go in and be hooked up to a machine three times a week for three or four hours. It's a big hassle."
Eight of the people were already on the waiting list for a new kidney; the others were still undergoing evaluation. Three told their Minnesota doctors they were planning to go overseas for their transplant -- one a full year before he went.
Infections a Major Problem
It was a mere 25 days after the procedure, on average, that the recipients sought follow-up care in the U.S. Canales notes that at her institution, kidney recipients are generally advised to take it easy for at least six week after transplantation.
In general, the transplant itself was a success. Two people initially rejected their new kidney, but one was treated successfully with antirejection drugs; only one person had to go back on dialysis.
But four of the 10 developed potentially life-threatening complications. One person with a severe wound infection "had pus coming out of his wound at the time of arrival in the U.S. He came off the plane and went straight to the emergency room." In and out of the hospital for three months, the person eventually developed a fungal infection in the brain and died.
Two people developed sepsis, a blood-borne infection marked by high fever; a third developed a viral infection known as cytomegalovirus (CMV) that raises the risk of eye infections and digestive problems. All three recovered.
Transplant Education Is Key
Canales says that follow-up care was hindered by the lack of communication between the foreign transplant surgeon and the U.S. doctors. "In general, we just got a piece of paper saying the kidney transplant went well. We didn't know what medications they were given at the time of transplant or what doses. There was little or no information on the donor," she says.
But with many of those who traveled overseas reluctant to share information about the source of their new organ, Canales doubts that will change anytime soon. Instead, she says, doctors have to take advantage of the fact that many people share, or at least hint at, their intents to go abroad and should educate them about the long-term risks before their journey.
Anthony M. D'Alessandro, MD, director of multiorgan transplantation at the University of Wisconsin in Madison, agrees.
"We know people are looking for ways to get a transplant sooner, but they really have to weigh the risk of staying on the waiting list against something that may be good in the short term but not long term. Education is key," he tells WebMD.
D'Alessandro notes that the situation is getting better in the U.S. "We've had a 17% jump in organ donors in the past two years," he says. "Prior to that the biggest increase in one year was 3%."
SOURCES: World Transplant Congress 2006, Boston, July 22-27, 2006. Muna T. Canales, MD, fellow, department of nephrology, University of Minnesota, Minneapolis. Anthony M. D'Alessandro, MD, director, multiorgan transplantation, University of Wisconsin, Madison. United Network for Organ Sharing web site.