Transplant Tourism in the United States: A Single-Center Experience
Jagbir Gill, Bhaskara R. Madhira, David Gjertson, Gerald Lipshutz, J. Michael Cecka, Phuong-Thu Pham, Alan Wilkinson, Suphamai Bunnapradist, Gabriel M. Danovitch
Background and objectives: Transplant “tourism” typically refers to the practice of traveling outside the country of residence to obtain organ transplantation. This study describes the characteristics and outcomes of 33 kidney transplant recipients who traveled abroad for transplant and returned to University of California, Los Angeles (UCLA) for follow-up.
Design, settings, participants, & measurements: Posttransplantation outcomes were compared between tourists and a matched cohort of patients who underwent transplantation at UCLA (matched for age, race, transplant year, dialysis time, previous transplantation, and donor type). Median follow-up time was 487 d (range 68 to 3056).
Results: Compared with all patients who underwent transplantation at UCLA, tourists included more Asians and had shorter dialysis times. Most patients traveled to their region of ethnicity with the majority undergoing transplantation in China (44%), Iran (16%), and the Philippines (13%). Living unrelated transplants were most common. Tourists presented to UCLA a median of 35 d after transplantation. Four patients required urgent hospitalization, three of whom lost their grafts. Seventeen (52%) patients had infections, with nine requiring hospitalization. One patient lost her graft and subsequently died from complications related to donor-contracted hepatitis B. One-year graft survival was 89% for tourists and 98% for the matched UCLA cohort (P = 0.75). The rate of acute rejection at 1 yr was 30% in tourists and 12% in the matched cohort.
Conclusions: Tourists had a more complex posttransplantation course with a higher incidence of acute rejection and severe infectious complications.
The demand for kidney transplantation continues to increase (1,2). Some patients opt to explore the option of kidney transplantation outside their country of residence (3). In the United States, the implications of this practice, often termed “transplant tourism,” remain largely unknown.
The observation of an increasing trend of patients who return from transplantations that are performed abroad led us to review the experience and outcomes with transplant tourism among patients who were followed in the UCLA Kidney Transplant program. We describe the characteristics and posttransplantation outcomes of patients who sought a transplant abroad and then returned to be followed at UCLA.