When 50-year old Dominador “Doming” Umandap, a resident of Calauag, Quezon, arrived home from Metro Manila sometime in early 2007, he had a fresh scar on his side and thousands of pesos in cash in his pocket—proof that he successfully donated his kidney.
A few months later, in August of the same year, Doming died of a heart attack.
In most countries, living organ donors generally lead normal and healthy lives long after donating a kidney. In fact, they are supposed to be part of the healthier segment of the population, Benita Padilla, a nephrologist at the National Kidney and Transplant Institute (NKTI) told Newsbreak. This is because before a person can donate, he is supposed to undergo a battery of medical examinations to determine if he is physically fit.
But in the Philippines, the rampant sale of human organs is distorting the process. New findings indicate that this distortion might have adverse consequences on the health of the “donors”. And kidney specialists said Monday the new health department guidelines on organ donation, published last week, will not help matters at all.
Medical History
With no access to Doming’s health records, specialists will not be able to determine with certainty if it was the kidney donation which triggered his heart failure. What is clear however is that, had all the medical requisites been followed, he should never have been allowed to donate at all.
Doming had always been always been hypertensive, his common law wife, 48 year old Rosalina Lopez recalled.
High blood pressure is one of the red flags that doctors watch out for in screening potential kidney donors. Others include abnormal kidney functions and protein in the urine. Persons with such conditions are supposed to be automatically rejected from the donor’s list.
That Doming was able to donate, despite his medical history, speaks volumes of the flaws in the screening of potential organ donors in the country.
Not isolated case
And new data indicate that Doming’s case is not isolated.
In a medical mission they conducted in Lopez, Quezon, the Philippine Society of Nephrologists (PSN) discovered these medical conditions in 109 donors examined:
- Above normal serum creatinine levels (average serum creatinine among donors examined was 1.4 mg/dl while the normal level is 1.3 mgdl);
- Below normal estimated glomerular filtration rate (GFR) or creatinine clearance rate (Average estimated creatinine clearance 66 ml/min among donors examined, while average GFR for donors in other countries, based on published studies, is 86 ml/min);
- Hypertension (16% had blood pressure at least 140/90 mm Hg, when a person with a blood pressure of 130/80 mm Hg is already considered hypertensive)
- Protein in the urine (Macroalbuminuria) - 2.8 % had protein in their urine, an indication of abnormality in the kidney which must be investigated.
All of the 109 donors examined by the PSN underwent physical examination, blood test for complete blood count and to determine serum creatinine levels, urine dipstick for blood, protein, and signs of infection.
Of the 109 kidney donors seen, 2 were related donors; 107 were non-related donors.
The average age of the donors examined in the PSN medical mission was 28 years old. These conditions are not supposed to be predominant in such a young population, Padilla said. “These are unexpected findings.”
While it will take some more years to find out if the donors examined by the PSN themselves will end up with kidney disease or heart conditions, Padilla said “the findings are not promising.”
Poor screening of donors
Dr. Benita Padilla talks to the press about the case of the organ trading in the Philippines at the present. (Photo by Buck Pago)
The PSN findings could mean two things, according to Padilla. “It could be that donation had a bad effect on them or that they were not screened well.” And doctors blame this on one thing: the rampant sale of kidneys in the country.
Typically, a donor undergoes the following tests before he is allowed to donate:
- Physical examination;
- Blood tests and urinalysis to check the health of his kidneys, rule out diabetes and under infections, and determine his blood and tissue types;
- Kidney ultrasound;
- Chest x-ray;
- Electrocardiogram;
- And renal angiography (x-ray of the arteries supplying blood to the kidneys)
These tests, however, only give doctors an idea on the current state of a patient’s health. Doctors also need a patient’s medical history to determine if he is pre-disposed towards certain illnesses.
Because health-seeking behaviour is often poor among low-income Filipinos, doctors typically rely on patients to report their medical history. Doctors expect patients to tell the truth about their medical conditions, Padilla said, because lying to a doctor can put a person’s health at risk.
Organ Donors Instructed by Brokers to Lie
But things tend to get distorted when financial considerations enter the picture.
During a visit to Quezon early this year, donors interviewed by Newsbreak recalled being instructed by organ traders to lie about their medical history and even substitute urine samples in order to pass muster.
In some cases, potential donors who have high blood pressure levels were also asked to take medication to normalize their blood pressure.
And the big motivation is money: a “donor” stands to earn around P110,000 to P130,000 selling his kidney. For Doming, the money seemed like their ticket out of poverty, his wife, Rosalina, said.
Before he donated, Doming earned only between P40 to P100 a day as a part-time tricycle driver. Rosalina earned from P120 to P300 a day selling fish. The house they lived in was a tiny hut, barely over a meter wide.
It came as no surprise then that, though rejected several times due to his high blood pressure, Doming kept going to the city until he was finally able to donate his kidney. “I told him not to do it because he is already old,” Rosalina said, but Doming insisted. “Nothing will happen to us if I don’t do something,” he told his wife.
New DOH Rules Do Not Help
Philippine hospitals are simply not set up to filter out such highly-motivated donors, kidney specialists said. And the new guidelines released by the health department will not help because it effectively removed limitations to the number of organ transplant operations allowed for foreign recipients.
“We want the AO revoked,” Lyn Gomez, PSN president told reporters during a press conference Monday in Quezon City.
Critics attribute the boom in organ trading to an increase in the number of foreigners coming into the country for organ transplants. From 307 in 2002, organ transplant operations in the country ballooned to 690 in 2006.
The guidelines instituted in 2002 required organ transplant centers to limit the number of transplant operations to foreign patients to only 10 percent of all transplantation operations for each year.
But many organ transplant centers have been habitually violating health department guidelines on organ transplant operations for foreigners.
Data from the Renal Disease Control Program of the National Kidney and Transplant Institute shows that for the year 2006, in 41.4 percent (286 of 690) of transplantation operations, the recipients were foreigners.
Only 404 of 690 kidney transplant recipients were either pure Filipino or of Filipino descent. The rest were foreigners. Of this number, the biggest number of recipients--107 patients--came from Saudi Arabia and other Middle Eastern countries.
The Renal Disease Control Program at the National Kidney and Transplant Institute only started monitoring data on ethnicity of patients in 2006, so the extent of kidney transplants on foreign patients in the Philippines recent years is not yet captured by the data.
Short-lived Benefits
Proponents claim that by providing for material benefits to donors, organ trading helps the poor.
But data from the field indicate that benefits donors derive from selling their organs are often short-lived. One donor who used his earnings to buy a tricycle had to sell it months later in order to pay for a child’s hospitalization.
The money from the sale of Doming’s kidney did allow him and his wife to pay off their debts and buy a slightly bigger hut.
But by the time Doming died five months later, Rosalina did not even have enough money left over to pay for his funeral expenses. – With research assistance from Rey Santos
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