Crossing Borders for Organs: A Case of Transplant Tourism

Introduction: Transplant tourism comprises up to 10% of organ transplants worldwide. It raises ethical concerns, can exploit vulnerable donors, and compromises recipient outcomes. Recipient complications may include inadequate pre-transplant care, missing medical records, post-operative complications, donor-transmitted infections or malignancies, and inferior allograft outcomes. Case Description: 43-year-old woman with chronic hepatitis B (HBV) and hepatitis D (HDV) coinfection and chronic kidney disease due to immune complex glomerulonephritis underwent a commercial preemptive living donor kidney transplant in Afghanistan from a male in his 20s. Details of her 3-week transplant admission were unavailable. She was given cyclosporine, mycophenolate, and prednisolone, without prophylactic antimicrobials or transplant education. She was told to follow up with doctors in the U.S. despite not being established with a transplant center. She presented to the hospital a month later with jaundice, cough, and was found to have: Infections: Extended-Spectrum Beta-Lactamase E. coli perinephric abscess and bacteremia, influenza A, cytomegalovirus viremia, untreated latent tuberculosis. Surgical complications: Urine leak and transplant renal artery stenosis. Decompensated liver disease: Prior to transplant, her HBV and HDV were well controlled on tenofovir alafenamide and bulevirtide. She stopped taking bulevirtide peri-transplant, which led to HDV reactivation. Her allograft function was stable throughout. Discussion: Transplant tourism may involve organ trafficking, undermining a country’s ability to care for its own population. It is considered illegal or unethical under the Declaration of Istanbul. Drivers of transplant tourism include a global rise in kidney disease coupled with an overwhelming demand for limited donor kidneys. Developing countries may have inadequate dialysis facilities, limited deceased donor programs, or few transplant services. Some patients may seek transplants abroad due to suspension from waiting lists or for fear of dying while waiting. As recipients return home, the responsibility of care falls on local transplant physicians, raising ethical concerns about beneficence versus a sense of complicity in organ trade. Physicians should document transplant circumstances, consult ethics, and ensure continued care even if it warrants transferring the patient.