Philippines slices unscrupulous scalpels
By Cher S Jimenez
MANILA - Click onto the www.liver4you.org website and global patients can - at
competitive rates - reserve living Filipino kidney, liver and bone marrow
transplants. The site boasts that the living organs will be transplanted at two
unnamed partner hospitals outfitted with "the most advanced Western equipment
in the world" and with the "full compliance of the Philippine Ministry of
Health". Transplants can be arranged in less than 10 days, according to the
site.
Welcome to the brave new world of Philippine transplant tourism, one of the
country's few growth industries. It's also a trade coming under tough
international scrutiny, due to concerns it sometimes provides cover for illegal
human organ trafficking syndicates. The World Health Organization (WHO)
recently ranked the Philippines
as one of the top five countries in the world for human organ trafficking,
along with China, Pakistan, Egypt and Colombia.
Medical tourism is booming in the Philippines, including among deep-pocketed
foreigners who seek organ transplants, most commonly kidneys. About 200,000
health tourists visited the Philippines in 2006, according to official
statistics. With this rapid influx, criminal human organ syndicates have seized
on the crowds and taken advantage of the government's weak law enforcement to
arrange illicit transplants for foreign nationals.
The official number of kidney transplants in the Philippines has recently risen
dramatically, climbing from 306 transplants in 2002 to 1,046 in 2007, according
to records compiled by the Philippine Renal Disease Registry. Over half of the
kidney recipients last year were foreigners, with Middle Eastern nationals
comprising 75% of the beneficiaries. It's unclear how many more operations have
taken place under the official radar.
As the number of foreign national beneficiaries rises, so has the number of
non-related living organ donors, a trend which undermines the intent of a 1991
Philippine law that supports cadaver and relative donations.
Benita Padilla, president of the local Society of Nephrologists, said what
makes the Philippines situation "unique" is that "transplants are done by big
hospitals" rather than in back-alley operations, like the other four organ
trafficking nations identified by the WHO.
Donors are often recruited from poor Filipino communities, particularly in
Manila, and paid sums ranging from US$2,000 to $3,000 per kidney, according to
health officials. Brokers have also started scouting for donors in Manila's
neighboring provinces and in central Philippines, according to Padilla.
In April seven men were rescued in a house in southern Luzon after they were
found locked up by an organ trafficking syndicate. The men were reportedly held
against their will by the criminal gang until it could arrange to sell their
organs to foreign patients, according to news reports. It was unclear if they
intended to sell the organs to government-accredited facilities or onto
underground markets.
Some say those are often one and the same in the Philippines. The profit motive
for underground syndicates and kidney transplant surgeons is exceptionally
high. The website www.liver4you.org advertises liver transplants for $130,000.
A foreign patient can expect to spend anywhere between $70,000 to $115,000 for
a kidney transplant in one of 20 government-accredited medical facilities.
That's a huge increment over the $19,000 to $23,800 hospitals charge lower
purchasing power Filipinos for the same kidney transplant procedure. Some
10,000 to 12,500 Filipinos develop end-stage renal disease every year, 50% to
60% of whom are kidney transplant candidates, according to medical sources.
However, less than 10% actually receive transplants, usually because of
insufficient organ supplies and the failure of local patients to raise
sufficient funds for the life-saving procedure.
Unscrupulous scalpels
An administrative order by the Department of Health (DOH) applicable to all
local hospitals previously put in place a 10% cap on all transplant procedures
for foreign nationals in any given year. That means the official figures of
transplants are probably highly understated, some experts say.
Enrique Ona, chief of the government-run National Kidney and Transplant
Institute, claims that some medical doctors are "responsible" for the
underground organ trade in the Philippines. He noted that there are only 24
registered kidney transplant surgeons in the country and that above-ground
transplant procedures are conducted in only about 20 licensed medical
facilities nationwide.
Those figures raise hard questions about why not a single hospital or medical
practitioner has been charged for violating the DOH order, which is binding by
law. The DOH has identified eight different medical facilities, including
government-run hospitals, for not abiding by the annual cap on kidney
transplants for foreign recipients. It has threatened to jail doctors and
hospital administrators for up to 20 years in prison if they continue to defy
government orders, but so far has not followed up on the threats with legal
action.
Under international pressure to combat perceived rampant organ trafficking, the
DOH with the backing of President Gloria Macapagal-Arroyo in March issued a new
directive banning outright kidney transplants for foreign patients. The policy
stated that kidney transplants were not part of the government's medical
tourism promotion campaign and aimed to prioritize needy Filipinos as organ
recipients.
The new ban also aimed to better regulate the local organ donation trade,
including government "gratuity packages" for organ donors. A new board chaired
by the Health secretary is also set to screen all future transplant recipients.
Now, the new directive faces more criticism than praise as signs of compromise
creep into the policy's implementation.
A group of local doctors has seized on a DOH exemption granted just weeks after
the new ban's announcement to eight Israeli nationals who have already, or are
scheduled to, receive kidney transplants. One Israeli patient already had a
transplant procedure at the government-controlled National Kidney and
Transplant Institute.
The DOH and the new transplant and donor screening board said that the Israeli
nationals were exempted from the ban for "humanitarian reasons" and because
they were on the list of beneficiaries long before the policy was announced.
The Philippine Society of Nephrologists and others have already accused the DOH
of contradicting itself in not immediately implementing the new policy.
Other medical practitioners have raised concerns that health officials will not
reveal how many more foreign patients may be granted exemptions because they
allegedly applied for transplants before the ban was issued. The lack of DOH
transparency, they fear, could work to the advantage of the same organ
trafficking syndicates the new policy supposedly aimed to uproot.
Cher S Jimenez is a reporter for the Business Mirror daily newspaper. She
was recently a Yuchengco media fellow at the University of San Francisco, where
she conducted research on undocumented Filipino migrants.
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