British Hospital’s Frequent Organ Transplants for Foreigners Draw Scrutiny

August 26, 2008 10:16 AM
by Anne Szustek
Surgeons from an NHS-run London hospital performed 50 liver transplants—about half on patients from the Persian Gulf—allegedly in exchange for about $160,000 per surgery.

Liver Transplants for Nonresidents Questioned

Surgeons at King’s College Hospital, a teaching hospital in the Camberwell district of South London, implanted livers donated by British residents from April 2003 to March 2008 allegedly for substantial payment. The hospital is run by the National Health Service, Britain’s state health plan.

U.K. paper the Daily Mail reports that 22 of the 50 patients receiving the livers were from Kuwait and the United Arab Emirates.

Non-EU British residents can use the NHS for nonemergency treatment, such as transplant surgeries, on a paying basis.

Thanks largely to their oil wealth, the state healthcare programs of Kuwait and the UAE send patients abroad if local healthcare providers judge that treatment involves procedures beyond local expertise. The UAE has been doing this less often recently because of the rise of private hospitals in the country, however.

About one-third of the 50 private patients received parts of livers from living donors such as relatives. But the rest received livers from donors who had had an untimely death, such as an accident.

British law stipulates that livers donated by U.K. residents may be furnished to non-EU private patients only if age or size problems prevented a match for people on British and EU waiting lists.
In addition, the United Kingdom’s Human Tissue Act of 1961 requires that would-be donors “opt in” to the NHS and state their wish verbally or in writing to two or more witnesses. If such a wish had not been formally stated prior to death, according to the Scottish government, the person who has the legal rights to the body may still donate its organs, provided that “reasonable enquiries” were made as to whether the deceased would have consented. The Human Organ Transplants Act of 1989 clearly prohibits the sale of organs.

The U.K. Healthcare Commission does not plan to investigate King’s College Hospital “because there is no evidence the Trust is breaking the rules,” according to the Daily Mail.

King’s College Hospital draws an international patient base. According to the hospital’s Web site, “The Liver service at King’s is probably the largest comprehensive clinical liver programme in the world.”

In July, NHS transplant authorities submitted the hospital for review by the Healthcare Commission over concerns about its issuance of livers to 72 non-British EU citizens during a four-year period. Greek and Cypriot citizens received 37 of those in “private” operations. From the start of 2008 until April, 18 of 24 liver transplants made by the hospital were to Greeks or Cypriots. In response to allegations that it was “selling” organs, King’s College Hospital said that the figures were due to Greece and Cyprus’s system of paying health care in the United Kingdom on a per-patient basis, rather than a block system used by most other EU countries.

In 2006, some 750 non-U.K. Europeans came to Britain for NHS treatment, largely for specialized care such as liver transplants, says the BBC.

Background: The worldwide organ trade

India and the Philippines have also made headlines recently as being source countries of paid transplant organs. Members of a medical team from a hospital near the Indian city of Delhi tricked some 500 low-paid laborers into believing they would be getting stints as day laborers. Instead they were forcibly put under and their kidneys were extracted.

Some of the victims received $1,275 for their kidneys, although reports show that the recipients of the organs paid up to 20 times that amount.

In a move to prevent poor residents from being taken advantage of by organ trading rings, the Philippines instituted a law in April that makes travel to the country to receive an organ from a non-relative a crime punishable by a prison sentence of up to 20 years. The Philippine Society of Nephrology said that the country is a “world ‘hotspot’ for human organ trafficking.”

Within the United States alone, some 100,000 are waiting for organ transplants, with a waiting time of up to three years. Some, including University of Pittsburgh medical researcher Harold Kyriazi, advocate for the sale of organs. Kyriazi, who runs the Web site, argues that if people were allowed to sell their organs, the supply of transplant organs would increase by 200 percent.

Claire Andre and Manuel Velasquez write in an article for the Santa Clara University Markkula Center for Applied Ethics entitled “Kidneys for Sale” that such a system would only benefit the rich. “People living in extreme poverty are often desperate and ill-informed. Profit-seekers would take advantage of this, obtaining ‘consent’ from those who feel compelled by necessity to sell their organs, and who may not have a clear idea of the consequences of what they were doing,” they point out.

Several U.S. universities are stepping in to alleviate the shortage of kidneys in the country in a not-for-profit kidney swapping pool. Baltimore’s Johns Hopkins Hospitals and New York-Presbyterian Hospital/Columbia Medical Center, among others, are coordinating a trading program for kidneys of donors who are not medical matches for their needy friends or relatives.

Reference: Organ transplant law and resources

The 2004 Organ Donation and Recovery Improvement Act (U.S.) assists living donors with the cost of travel, subsistence and incidental non-medical expenses.

The Organ Procurement and Transplantation Network offers comprehensive information for people waiting for kidneys, including briefings on recent laws passed concerning organ donations and a list of transplant centers organized by organ and state.

Related Topic: NHS under Pressure

In June, six British cancer patients filed legal action against the NHS because of its “top-up” medical policy. Under this plan, if one receiving treatment under the British state health plan pays privately for drugs, they lose eligibility for state-funded treatment. The recent death of Lisa O’Boyle, a cancer patient who was instructed to take the drug Cetuximab, which the NHS deemed not to be “cost-effective,” brought national attention to the issue. In August, the NHS rejected four kidney cancer drugs for coverage—Sutent, Avastin, Nexavar and Torisel—on the same grounds.

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