liver transplant abroad

[chris777777]

I am thinking of visiting China,with a view of arranging a liver transplant.From internet research I have done,First Central hospital in Tianjing,with its own organ transplant centre,appears to be one of the most professional and successful centres for this procedure in China.Do you have any knowledge re this?Thanks.

[Thomas D Schiano, MD]

i do not have any specific knowledge of this program's results.  i am glad that you are doing your research with this.  Some programs will definitely not have good results.  make sure that you get all your records after the transplant and have enough immunosuppression to last you, as well as a doc to take care of you upon your return.

[chris777777]

I HAVE SPENT SEVERAL WEEKS IN INDIA AND VISITED MANY HOSPITALS RE A CADAVER LIVER TRANSPLANT.BASICALLY FROM THE CONVERSATIONS I HAD WITH THE LIVER SURGEONS THERE,A CADAVER TRANSPLANT FOR A FOREIGN PERSON IS VIRTUALLY IMPOSSIBLE-INCLUDING APOLLO,AS THEY ARE SO SHORT OF ORGANS FOR THEIR OWN PEOPLE.YES,YOU WILL GET A MEDICAL VISA,BUT UNLESS YOU CAN PROVIDE A LIVING DONOR YOU WILL NOT RECEIVE A LIVER.

[gilmane]

I have been in your place ten years ago. I was in the hospital for three months with ESLD and serious additional medical problems requiring surgery but which could not be performed due to the inability of my blood to clot.  My liver had caused my spleen to stop making platelets. I was in need of an immediate liver transplant but my serious medical complications did not move me any higher on the transplant list for a cadaveric liver. (Pre MELD score). The transplant team said I needed a living donor transplant ASAP. My sister volunteered and was tested in her local area and met the preliminary requirements for a living donor. The Transplant Center scheduled the operation and she flew in for the surgery.  On the day the surgery was scheduled they needed to perform the final tests to verify that she was both a compatible donor and that the surgery would be safe for her. She was determined to have a slightly fatty liver and was not deemed a viable donor.  With no other living donor candidates in sight I left the hospital and returned home to prepare to die. My wife started searching for possible out of country transplant. We evaluated China, Pakistan, Egypt, Colombia, India and the Philippines.  We found several possible candidates and talked to our in country transplant team about the viability of this course of action. It is during this evaluation that we became aware of the potential problems both ethically and medically. The team stated that I may be subject to sub-standard surgical techniques, poor organ matching, unhealthy donors, the lack of documentation associated with the transplant event and hospitalization and post transplant infections. They also pointed out that a prolonged stay may be required post transplant depending on complications,that my wife or another care giver would be required to accompany me during the entire stay and that my transplant and other surgeries would require a first rate medical team if I were to survive. We had discovered that many studies show about 90% of Chinese transplant organs come from executed "prisoners" with dubious consent.   After a difficult and emotional period of evaluation, we decided that an out of country transplant would not work for us.
Just as I was convinced that there was no hope, a viable living donor became available and I was able to have the liver transplant and other surgeries at my transplant center. I realize every day how fortunate I am.
Some of the countries we evaluated no longer offer transplants to visitors or put them behind locals in the organ priority. The Colombian government in 2004 enacted a law to make sure transplant centers exhaust all possibilities of offering available organs to Colombian natives before they are offered to foreigners. Organ transplants in China are covered by the 2007 regulations that establish national oversight and credentials for Chinese transplant officials. The regulations ban transplant tourism for foreigners. China’s Ministry of Health is targeting illegal organ transplants, after reports surfaced that some hospitals were illegally doing organ surgeries for foreigners.
If faced with the same circumstance today I would consider India for further evaluation.  Apollo hospital in Chennai, Jaslok Hospital in Mumbai, and St.Johns Hospital in Bangalore and CMC Hospital in Vellore are names of some of the hospitals that perform liver transplantation in India. Moreover the Indian Government has recently started issuing medical visa to those who are visiting the country for medical treatment, thus making it easier for patients from abroad. There is still no guarantee of receiving a liver.
I am not categorically against foreign transplants, I feel they should only be used as a last resort and that the organ recipient be knowledgeable about the level of medical care and follow-up  they will receive as well as how the offer organs are made available.
I wish you and your family the best. I do know what you are going through.

[chris777777]

DO YOU SERIOUSLY THINK I HAVE NOT EXPLORED THE POSSIBILITY OF HAVING A LIVING DONOR TRANSPLANT-IN MY CASE IT IS NOT POSSIBLE.PERHAPS YOU SHOULD CONSIDER WHAT YOU WOULD DO IF YOUR LIFE WAS ON THE LINE,AND CHINA OFFERED THE ONLY HOPE!!PERHAPS THEN THE HIGH MORAL GROUND WOULD SEEM LESS ATTRACTIVE.

[gilmane]

Before looking to China for a tourist liver transplant be aware that according to the New York Times Feb 17, 2009, China has banned all transplants for foreigners — so-called organ tourists — because an estimated 1.5 million Chinese are on waiting lists for transplants. The ban was issued May 1, 2007. (http://www.nytimes.com/2009/02/18/world/asia/18organs.html).  In addition there are ethical issues to be considered since many studies show most Chinese transplant organs come from executed prisoners with dubious consent and uneven testing (see http://www.independent.co.uk/news/world/asia/most-chinese-transplant-organs-come-from-executed-prisoners-1777370.html dated August 2009). Also, you should read an article in The Lancet "Government policy and organ transplantation in China"  published October 20, 2008. (http://www.thelancetglobalhealthnetwork.com/wp-content/uploads/Health-System-Reform-in-China-CMT-11.pdf)
You might want to consider a living donor transplant from a relative or friend instead as an option.