The Department of Health’s (DOH) new policy on kidney donation, published Thursday in some Manila newspapers, could lead to more foreign patients suffering from end-stage kidney disease coming to the Philippines for their transplants as other countries clamp down on the kidney organ trade.

In an interview with abs-cbnNEWS.com/Newsbreak, Dr. Leonardo de Castro, program director of the University of the Philippines (UP) Bioethics Program, said that while the new policy says that “kidney transplantation is not part of medical tourism, the opportunity for foreign patients to come to have their transplants done in the Philippines remains.”

De Castro said the new DOH policy must be viewed in light of developments on organ donation around the world.

In India, Pakistan, and China, De Castro said new laws have been passed to control the selling of organs.

If these new laws are able to limit kidney transplants in these countries, De Castro said the Philippines could end up receiving more foreign transplant patients.

De Castro said he has received reports that commercial kidney brokers are now looking at the Philippines as the alternative venue for their clients.

The Catholic Bishops Conference of the Philippines (CBCP) has criticized the increasing “organ sale, especially of kidneys” in the Philippines.

In a January 27, 2008 statement, CBCP President Angel Lagdameo said the organ trade is “a practice that is perhaps apparently permitted by some physicians, Kidney Transplant Teams, and hospital authorities.”

Same open policy for foreign patients

Prior to the issuance of the new policy, De Castro said the DOH already allowed foreign patients to come to the Philippines for kidney transplants. This has enabled hundreds of foreigners, such as Arabs, Japanese, Koreans, Americans, to get a kidney from Filipino donors for around P100,000 ($2,500).

It also spawned a black market of organ brokers who went to urban poor communities, such as the BASECO in Tondo, Manila, to look for donors. Brokers normally earned P20,000 ($500) for each donor who qualified for a transplant. The outright cash deal left donors initially happy, but they remained poor since they often quickly used up their money to pay for debts and to meet basic needs.

De Castro said majority of the estimated 500 kidney transplants that have been done annually in the Philippines in recent years were on foreigners suffering from end-stage renal disease.

A kidney transplant in a facility like the state-owned NKTI costs around P800,000 for both patient and donor. This excludes post-operation treatment and medication. At such cost, only rich Filipinos and foreigners can afford kidney transplants.

The DOH has estimated that only around 10% of Filipinos suffering from end-stage kidney disease are transplanted due to lack of kidney supply and the “unaffordability of the operative procedure to most patients.”

The organ donation system in the Philippines contrasts sharply with countries like Iran, where the government subsidizes the full cost of kidney transplants of poor patients. It also bans foreign transplant patients.

Under the previous DOH policy, it was recommended that kidney transplant hospitals limit the number of foreign transplant patients to 10%. But De Castro said this was never followed in most private hospitals.

Only the NKTI complied with the 10% ceiling on foreign patients, he said.

Medical tourism

In a separate interview, Dr. Gene Nisperos, secretary-general of the Health Alliance for Democracy (HEAD), expressed the same concern as De Castro, saying the new DOH policy “may expedite transplants of foreign patients,” which would then worsen the organ trade.

He noted that the government is actively promoting the Philippine Medical Tourism Program. Some of the hospitals in the program offer kidney transplants, and this may “open the floodgates” to foreign transplant patients.

A check with the Philippine Medical Tourism Program website www.philippinemedicaltourism.info showed that organ transplantation (kidney, liver, bone marrow) is still included as one of the medical services being offered by the NKTI, a state-owned hospital included in the program.

Nisperos said the government is now marketing medical tourism, including organ transplants, in many countries.

Nisperos said the HEAD is still studying the new policy to see if there are loopholes which organ brokers could use to promote their business.

He said it remains to be seen how far the DOH will be in investigating or sanctioning members of the medical community who promote commercial organ donation and violate the new rules.

Foreign patient subsidy

Health Undersecretary Alexander Padilla, meanwhile, has said the new DOH policy will lead to a new system wherein a foreign patient will be required to pay for the operation of a poor Filipino suffering from end-stage kidney disease.

He said foreigners will not end up getting most of the donated kidneys from Filipinos since they have to pay for the operation of a Filipino patient and that of his donor.

“The foreigner will have a counterpart indigent patient. So, at the very least, it will be one-to-one,” he said.

Poor Filipino patients who cannot afford kidney transplants will thus be able to get a new lease on life.

Padilla said the plan is to have a central clearing system of kidney donors and patients. A foreigner can no longer suddenly come with his donor to have the transplant operation in the Philippines.

The foreigner will have to queue for a kidney just like all the other patients. This eliminates the need for an organ broker since there will be a queued list of kidney donors and patients.

Padilla said the new system will have foundations that will provide sustainable livelihood, health insurance and good health care to Filipino kidney donors in order to ensure that they will not be exploited.

Sounds good

De Castro and Nisperos said the plan to have a foreign patient subsidize the Filipino poor patient sounds good on paper, but they want to see how it will be implemented and whether it will really eliminate the bad practices in the current organ trade.

As he had pointed out, De Castro said that the old policy which set a 10% ceiling on foreign patients didn’t work.

De Castro said “while it looks good in theory,” it may fail in practice. “I hope it works,” he said.