Curbing transplant tourism: Canadian physicians and the law.

Organ transplants can be a life-saving option for individuals with organ failure, but access is often limited for various reasons, including an imbalance of supply and demand. Canadians are among those who travel abroad to obtain organs through commercial transactions.1–3 This practice — often called transplant tourism — has been condemned by the international community,4,5 including the World Health Organization, and is illegal in many countries, including Canada. Physicians can play a pivotal role in discouraging transplant tourism, particularly if they are supported by law and policy reform. Concerns about the exploitation and harms donors experience through transplant tourism are considerable.6 Data on the experiences of organ recipients who obtained kidneys via illegal commercial transactions similarly reflect a range of adverse results, including surgical complications, diverse and sometimes unconventional infections, increased risk of late allograft loss and poorer outcomes overall, as compared with domestic transplant recipients.2,3 The implications of transplant tourism for domestic health care systems can also be serious. For example, a study of the clinical outcomes of patients treated at an Ontario transplant centre after receiving organs through commercial transactions abroad found that most of the patients needed follow-up care on an urgent basis and some required lengthy hospital stays.3 Many patients considering transplant tourism have ongoing health issues that are being managed by physicians in the Canadian health care system. In a study in British Columbia, the majority of patients who received a kidney graft through transplant tourism had been identified as potential transplant candidates in the domestic system.1 Physicians faced with a patient contemplating transplant tourism may encounter various legal and ethical challenges in determining how much and what kind of care and support to provide, both preand postoperatively. However, these interactions also present opportunities for physicians to help discourage this practice. Research suggests that individuals who obtain grafts through transplant tourism share certain characteristics that may facilitate early identification and deterrence efforts by physicians who are alert to particular risk factors among their patients.1 If a physician knows or has reason to believe that a patient is considering transplant tourism, he or she should, as part of the informed consent process and the fiduciary obligations to the patient, disclose information about the risks, including a candid assessment of the potential health hazards outlined earlier and other risks such as the lack of continuity in clinical care, inadequate records and risks associated with premature postoperative travel.3,5 Physicians may also consider discussing the potential harms to organ “donors” in commercial transactions6 and the illegal nature of the activity. Although such information may fall beyond the usual disclosure process, it seems something a reasonable person in the patient’s position would want to know (which is, broadly speaking, the standard for disclosure in Canada).5 A physician who is strongly opposed to transplant tourism should perhaps consider disclosing that to the patient as well. A clear conflict between a physician’s strong objection to the practice and a patient’s desire to obtain an organ may affect the physician–patient relationship7 and thus should be disclosed as part of the consent process. Indeed, article 12 of the Canadian Medical Association’s Code of Ethics requires the disclosure of personal values that may influence patient care. The hope is that the more patients know about the issues and risks associated with transplant tourism, the less likely they will be to pursue it. However, more research is needed to examine the impact of such disclosures. At a minimum, these legal and professional obligations support physicians to act in a Curbing transplant tourism: Canadian physicians and the law