Key issues in transplant tourism

Table 1 Types of living donation

Genetically related
1st degree relative	Parent, sibling, offspring
2nd degree relative	Grandparent, grandchild, aunt, uncle, niece, nephew
Other	Cousin
Emotionally related	Spouse, in-laws, adopted, friend
Unrelated (not genetically or emotionally related)	Directed (possibility of donor-recipient financial arrangement)
	Non directed (altruistic)
	Paired exchange
	Living-deceased exchange

Table 2 Outcome of living donor renal transplantation performed outside recipient countries

Study (country), period	n	Graft survival (%)		Patient survival (%)		Type	Comments
		1-yr	5-yr	1-yr	5-yr
Tsai et al[6] (United Arab Emirates), 1987-2006	215T	55.0		81.5		Both LRD and LURD	China; 10-yr survival figures; Higher risk of cancer in T group
	321H	60.0		89.3
Kennedy et al[23] (Australia), 1990-2004	16	66.0		85.0		LURD	Commercial transplants in India and China. Aspergillosis in one patient
Kwon et al[25] (South Korea), 1999-2005	462T	96.8 (death censored)		96.5		LURD	All transplants performed in China. Fifteen patients died; 42.5% complication rate. Results based on returning patients’ accounts
Ivanovski et al[41] (Macedonia), 2006-2007	36T	60.0		78.0			Transplants in India and Pakistan; 16/36 wound infections; active HCV+ in 9; seven died; 3 MI; TN in 3; 56% developed complication in early post op period. Acute rejection in 9/36. Poor communication
	H	100.0		100.0
Krishnan et al[42] (UK), 1996-2006	36T	87.0		83.0		Commercial	Indonesians in the UK. Poor clinical outcome in tourists - 42% had major infections
	40H	97.5		97.5		Living donor in UK
Rizvi et al[43] (Pakistan), 1997-2007	180	94.0	80.0			LRD	Mortality 16 (6%) for LRD and 34 (27%) for LURD
	126	86.0	45.0			LURD
Sever et al[44] (Turkey), 1992-1999	115		66.0		80.0		Commercial transplants in India, Iran, Iraq. Significant medical complications
Ackoundou-N’Guessan et al[45] (Ivory Coast), 1995-2009	16T	93.0	80.0	93.0	53.0	Both	Patients from Ivory Coast; two losses from AR; 5/16 died during period; death-censored graft survival
Gill et al[46] (US), 1995-2007	33	89.0					Transplants in China, Iran, Philippines, etc.; three graft losses; 17/33 (52%) had infections; one death; AR 30% vs 12% in home transplants; survival figures inferior to cohort of 66 matched local patients
	UCLA	98.0				UCLA - University of California Los Angeles
Geddes et al[47] (Scotland), 2000-2007	18						Travel from Scotland to Pakistan for transplants. No deaths; Malaria in one; acute rejection rate 11.1%; eGFR at 1 yr 51.8 mL/min every BSA1.73 m2
Majid et al[48] (United Arab Emirates), 1993-2009	45	100.0	100.0	100.0		LRD (10)	Paediatric; DBD 2; three death within 4 mo of transplantation; 10-yr survival
		87.8	43.4	91.2		LURD (33)
Ghods[49] (Iran), 1986-2006	1995	90.5	74.4	93.9	87.1	496 LRD; 1499 LURD	Kaplan-Meier estimates; rates for LURD. 10-yr graft and patient survival rates were 49% and 72% respectively. Paid and regulated system in Iran
Rizvi et al[50] (Pakistan), 1990-2002	1000	90.0	75.0	95.0	85.0		Private-public partnership model
Salahudeen et al[51] (United Arab Emirates/Oman), 1984-1988	131			81.5			Transplants performed in India. 25 deaths in first year; HIV = 5; HBV = 3; Septicaemia in 4. Insufficient information to patients
Morad et al[52] (Malaysia), 1990-1996	289	90.0		93.0		India	Comparable results to local transplants
	126	90.0		92.0		China
	258	91.0		96.0		Local (Malaysia)
LURD Transplant Study Group 1997[53], 1978-1993	540	90.0	72.0	97.0	92.0	Commercial	22 centres in India; Higher infection risk amongst commercial transplants: Hep B infection 8.1 v 1.4 in commercial renal transplantation
	75	90.0	83.0	95.0	91.0	Emotionaly related
UK Transplant[54], 2002-2004	1000	95.0	90.0	98.0	96.0	Both	First transplants only