Saturday, February 9, 2008

Organ-transplant black market thrives in India

Organ-transplant black market thrives in India

globeandmail.com: B.C. performs record number of life-saving organ transplants

globeandmail.com: B.C. performs record number of life-saving organ transplants

'I am just a doctor': alleged kidney transplant ringleader

'I am just a doctor': alleged kidney transplant ringleader

Monday, February 4, 2008

Patient Alert: New Study Finds Most Organ Transplant Patients Are Unaware of Their Increased Risk for Skin Cancer

Patient Alert: New Study Finds Most Organ Transplant Patients Are Unaware of Their Increased Risk for Skin Cancer
SAN ANTONIO, Feb 01, 2008 /PRNewswire via COMTEX/ -- As the number of organ transplants continues to increase throughout the world, so too are the number of organ transplant recipients developing skin cancer. Due in large part to the immunosuppressive medications required to prevent organ rejection, skin cancer among patients receiving solid organ transplants -- such as kidney, heart, liver, or lung, among other organs -- also tends to be more aggressive and spreads more quickly than in other patients. Now, new research demonstrates the need for more comprehensive patient education and management of skin disease in transplant patients to try to reverse these rising skin cancer rates.

Speaking today at the 66th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Summer R. Youker, MD, FAAD, assistant professor of dermatology at Saint Louis University School of Medicine in St. Louis, Mo., discussed the reasons why organ transplant patients failed to see a dermatologist and did not practice proper sun protection, despite educational efforts advising these practices.

"Educating transplant patients about the risk of skin cancer is essential, but multiple studies have shown that education during their hospital stay is not retained by patients and is not enough to change patient behavior regarding sun protection," said Dr. Youker. "Our findings confirmed that the majority of transplant patients surveyed did not know they were at risk of developing skin cancer, and many of the reasons they gave for not practicing proper sun protection or seeing a dermatologist could be remedied by developing an intensive educational approach that raises awareness of the prevalence of this real health threat."

In 2006, there were 29,000 solid organs transplanted, contributing to a total of 223,000 people living with functioning organ transplants in the United States at the end of that year. The incidence of skin cancer in solid organ transplant recipients is up to 200-fold that of age-matched controls due mostly to the required immunosuppressive medications. Dr. Youker cited studies that show that as many as 82 percent of kidney transplant recipients develop skin cancer 20 years after transplantation, and a study of Australian heart transplant recipients found that 27 percent of deaths occurring four years after transplantation were due to skin cancer.

In Dr. Youker's study, a total of 298 solid organ transplant patients (65 percent males and 35 percent females) who attended the outpatient transplant clinics at Saint Louis University completed a two-page survey to evaluate their comprehension of skin cancer risk, their compliance with skin cancer preventive measures, and their attitudes about sunscreen use and skin screenings. Dr. Youker reported that 62 percent of respondents did not know they were at risk for skin cancer, and 73 percent of respondents stated that they were not informed about the risk of skin cancer following their organ transplant. In fact, only 21 percent of patients had seen a dermatologist since their transplant, with even less (14 percent) receiving annual skin exams.

Of the reasons respondents gave for not seeing a dermatologist, 64 percent said they "did not know about the increased risk" and 7 percent said that they "do not want to attend another doctor's appointment." Only 28 percent of respondents reported wearing sunscreen regularly, a slight increase from 22 percent who reported wearing sunscreen regularly before transplantation.

Reasons for not wearing sunscreen varied widely among survey participants -- 33 percent responded "I forget to put it on," 25 percent said "I don't think it is important to use sunscreen," 16 percent said they are "not in the sun very much," 11 percent said "I like looking tan," 8 percent said they "don't like the way it feels," and 5 percent said it "takes too much time to put on."

"Because the time around an organ transplantation is consumed with the more pressing issues of rejection and infection, patients cannot be expected to recall information regarding the risks of sun exposure," explained Dr. Youker. "Clearly, another method of informing patients of this risk is needed -- preferably one involving dermatologists, who can assist the transplant team with strategies to educate and treat this high-risk patient population."

Dr. Youker cited a related study, "Educational Outcomes Regarding Skin Cancer in Organ Transplant Recipients," published in the June 2006 issue of the Archives of Dermatology, that found that the patients who received an intensive educational program in which written reminders reinforced the risk of skin cancer fared significantly better in terms of complying with the recommended sun protection tips than those patients who did not receive this education.

"Regular correspondence with transplant patients concerning the risk of skin cancer and referral to a dermatologist for initial skin screening, assessment of risk factors and detailed education about skin cancer prevention could help reduce the incidence of skin cancers in these patients," added Dr. Youker.

Sun exposure is the most preventable risk factor for skin cancer. The Academy recommends that everyone follow these sun protection guidelines:

-- Generously apply a water-resistant sunscreen to all exposed skin using
a Sun Protection Factor (SPF: 4.52, -0.23, -4.84%) of at least 15 that provides
broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet
B (UVB) rays. Re-apply every two hours, even on cloudy days, and after
swimming or sweating. Look for the AAD SEAL OF RECOGNITION(TM: 109.88, +0.08, +0.07%) on
products that meet this criteria.

-- Wear protective clothing, such as a long-sleeved shirt, pants, a
wide-brimmed hat and sunglasses, where possible.

-- Seek shade when appropriate, remembering that the sun's rays are
strongest between 10 a.m. and 4 p.m. If your shadow is shorter than
you are, seek shade.

-- Use extra caution near water, snow and sand as they reflect the
damaging rays of the sun which can increase your chance of sunburn.

-- Protect children from sun exposure by applying sunscreen.

-- Get vitamin D safely through a healthy diet that may include vitamin
supplements. Don't seek the sun.

-- Avoid tanning beds. Ultraviolet light from the sun and tanning beds
can cause skin cancer and wrinkling. If you want to look like you've
been in the sun, consider using a sunless self-tanning product, but
continue to use sunscreen with it.

-- Check your birthday suit on your birthday. If you notice anything
changing, growing, or bleeding on your skin, see a dermatologist. Skin
cancer is very treatable when caught early.

TorontoSun.com - Canada - Global medical tourism feeds organ scams

TorontoSun.com - Canada - Global medical tourism feeds organ scams
"The good the bad and the ugly."

That's how Calgary-based Aruna Thurairajan defines the complexities of the organ transplant business.

She's the Canadian connection for Fortis Healthcare, a group of 12 state-of-the-art hospitals in India and involved in helping people get organ transplants in India, Pakistan, Philippines and other countries.

I recently interviewed Thurairajan about the major kidney transplant scam in India involving as many as 500 people who were allegedly duped by unscrupulous doctors, nurses and hospital staff who drugged these poor people and then removed their kidneys for transplants to wealthy patients, many from other countries.

Reports allege that the ring leader of this scam -- known by the Indian media as "Dr. Horror" and "Dr. Kidney" -- is Dr. Amit Kumar, who may be on the run in Canada. One report says his wife Poonam, 28, and two boys 5 and 4 years old, live in Brampton in a $610,000 home that Kumar bought last year.



"Kumar, who at present is in the centre of this kidney scam, was arrested in Mumbai some years ago," India's highly regarded journalist Surendera Nihal Singh told me.

"He was released on bail and jumped bail ... The city of Gurgaon is an obvious place for such operations because it is emerging as the hub of multinationals and since police haven't kept pace with the phenomenal expansion, implementation of regulations is lax.

"The corruption is rife and the bribes offered are considerable, so the Indian government is talking about relaxing the strict laws on kidney transplants in order to discourage black market trade."

The illegal kidney transplant racket started flourishing in India and elsewhere after the discovery of cyclosporine and other drugs that greatly reduce the risk of an organ being rejected by the body.

Under the Organ Transplantation Act of 1994, India prohibits sale of organs but cadaveric organs are allowed to relatives.

When asked whether such a scam is possible, Nihal Singh said "it's really a question of supply and demand.

"Those on the lookout for kidneys are desperate and since many of them, Indians and foreigners alike, are relatively wealthy and prepared to pay some $30,000 to $40,000, there are takers. Those who indulge in the trade resort to subterfuge and bribe the police to look the other way," Nihal Singh said.

"The TED Case studies regarding India's kidney trade, conducted a few years back, dubbed India as a 'warehouse for kidneys' or a 'great organ bazaar' and that the country has become the largest centre for kidney transplants in the world."

Thurairajan knows first hand that the kidney scam "is very much possible." But reports claiming people were threatened by hospital staff armed with handguns don't sound credible to her.

"But I know doctors and their agents have lured poor people, taken them to five-star hotels, which is a heaven for these poor people," she said. "Their food is drugged and kidneys removed."

A few years back, when Thurairajan worked for a nursing home in Bangalore, known as India's Silicon Valley, she would see "how some local physicians would bring poor people from neighbouring towns and villages promising them work, subject them to a complete medical check up as pre-requisite for work and after being sure they were healthy, would drug them and remove their kidneys and other organs."

Years ago the Bangalore Police busted "a massive racket involving kidneys of over 1,000 unsuspecting poor persons in which a number of prominent doctors were involved."

But doctors don't have to resort to criminal activity as there are many people willing to sell their kidneys in India, Thurairajan said.

Organ transplants has become "the good the bad and the ugly" because of "the global medical tourism," she said, and that's what she proclaimed loudly last December at the international Organ Donation Congress in Philadelphia, where she was among the speakers .

She also disagrees with reports that only rich people "from affluent countries go to developing or under-developed countries which provide these services as 98% of my patients have begged, borrowed, mortgaged or sold assets to get an organ transplant."

It is a criminal offence for any foreigner to go to India or Pakistan for an organ transplant. The sale of organs is not legal in these countries.

"But from time immemorial organs have been traded for cash," Thurairajan reminded me. "It is kind of an unwritten thing."

Pakistan put a strict ban on the sale of organs Sept. 4, 2007.

"And the World Health Organization is watching them closely," she said. The result is people from Pakistan are now going to India for kidney and liver transplants.

The sale of organs is legal in the Philippines and Colombia.

"In Colombia people don't want organs from people who are over 35 years of age. There are plenty of organs for sale there, same as in the Philippines," Thurairajan said, adding that's where she now sends her patients.

It's been reported during this recent scandal in India that some of the kidney recipients were from Greece. They were arrested and their passports were seized. Thurairajan believes such widely published reports will deeply hurt the organ business. But she conceded "regardless of this being illegal, the transplant business continues behind the curtains" and, sadly, it happens "with the connivance of large hospitals and feeder clinics from the villages."

It costs $20,000 U.S. to get a kidney transplant in China and other organs could go as high as $90,000, although it's illegal for foreigners to receive transplants there.

It could cost $55,000 U.S. for a kidney transplant in the Philippines, where it is legal.

Some people in Toronto have waited seven years for an organ match, according to Jeffrey Zaltzman, director of the renal-transplant program at St. Michael's Hospital.

He said he recently examined a patient with a scar on his abdomen -- the result of a kidney transplant in India, or so the patient thought.

He was surprised to discover through an ultra-sound there was no transplant kidney.

NDTV.com: Mumbai Church issues plea for organ donations

NDTV.com: Mumbai Church issues plea for organ donations

Mumbai Church issues plea for organ donations.

Dharmesh Thakkar
Monday, February 4, 2008 (Mumbai)
A church in suburban Mumbai has decided to include in its Sunday mass a message to its parish to donate organs.

It's a quick response from the church in reaction to the kidney scam that has grabbed headlines in recent times.

The church in the western suburbs of Mumbai has been urging parish members to pledge their organs for cadaver donations at its Sunday mass.

This includes announcements on the importance of donating organs, inviting doctors to clear myths and misconceptions.

''Jesus gave his life so that others could live, so why not we follow him and donate our organs so others get a life; that is what Christianity or other religions teach,'' said Fr Leslie Almeida, St Francis Xavier Church.

The appeal has evoked enthusiastic responses with people instantly signing up to pledge their organs.

''I was not aware of this but after coming here I realised that my body can be used. If some part of my body can be used to help somebody alive,'' said Angelina Nimma, Parish Member.

Doctors say that the number of patients with organ failure is constantly growing and the lack of adequate number of donors continues, forcing transplant surgeons to explore new avenues for donors.

''There are more than 900 recipients for kidney transplant, 55 need liver and 10 for heart but the donors are simply not available,'' said Dr Vatsala Trivedi, Chairperson, National Deceased Donor Transplantation Network.

Awareness that can go a long way in stopping illegal human organ trade and give hope for those in need of transplants.