Commercial renal transplantation: A risky venture? A single Canadian centre experience

Authors

  • Anil Kapoor Division of Urology, McMaster University, Hamilton, ON
  • Kevin G. Kwan Division of Urology, McMaster University, Hamilton, ON
  • J. Paul Whelan Division of Urology, McMaster University, Hamilton, ON

DOI:

https://doi.org/10.5489/cuaj.692

Abstract

Background: Canada, akin to other developed nations, faces the
growing challenges of end-stage renal disease (ESRD). Even with
expanded donor criteria for renal transplantation (the treatment of
choice for ESRD), the supply of kidneys is outpaced by the escalating
demand. Remuneration for kidney donation is proscribed
in Canada. Without an option of living-related transplantation
(biological or emotional donors), patients often struggle with long
waiting lists for deceased donor transplantation. Accordingly, many
patients are now opting for more expedient avenues to obtaining
a renal transplant. Through commercial organ retrieval programs,
from living and deceased donors, patients are travelling outside
Canada to have the procedure performed.

Methods: Between September 2001 and July 2007, 10 patients (7
males, 3 females) underwent commercial renal transplantation outside
Canada. We describe the clinical outcomes of these patients
managed postoperatively at our single Canadian transplant centre.

Results: Six living unrelated and 4 deceased donor renal transplantations
were performed on these 10 patients (mean age
49.5 years). All procedures were performed in developing countries
and the postoperative complications were subsequently treated
at our centre. The mean post-transplant serum creatinine was
142 mmol/L. The average follow-up time was 29.8 months (range:
3 to 73 months). One patient required a transplant nephrectomy
secondary to fungemia and subsequently died. One patient had a
failed transplant and has currently resumed hemodialysis. Acute
rejection was seen in 5 patients with 3 of these patients requiring
re-initiation of hemodialysis. Only 1 patient had an uncomplicated
course after surgery.

Discussion: Despite the kidney trade being a milieu of corruption
and commercialization, and the high risk of unconventional
complications, patients returning to Canada after commercial renal
transplantation are the new reality. Patients are often arriving without
any documentation; therefore, timely, goal-directed therapy for
surgical and infectious complications is frequently delayed because
of the time taken to establish an accurate diagnosis. Refuting the
existence of commercial renal transplantation may not be a practical
solution; more consistent communication and documentation
with transplant teams may be more pragmatic. In the current climate,
patients considering the option of overseas commercial renal
transplantation should be advised of the potential increased risks.

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Author Biographies

Anil Kapoor, Division of Urology, McMaster University, Hamilton, ON

Kevin G. Kwan, Division of Urology, McMaster University, Hamilton, ON

J. Paul Whelan, Division of Urology, McMaster University, Hamilton, ON

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How to Cite

Kapoor, A., Kwan, K. G., & Whelan, J. P. (2013). Commercial renal transplantation: A risky venture? A single Canadian centre experience. Canadian Urological Association Journal, 5(5), 335–40. https://doi.org/10.5489/cuaj.692

Issue

Vol. 5 No. 5 (2011): October

Section

Original Research

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