title: Transplant tourism to China: the impact on domestic patient-care decisions.
abstract: Organ procurement in China has been criticized because of its reliance on executed prisoners as donors. We aimed to assess the influence of perceptions about organ procurement practices in China on domestic patient-care decisions.
  
  
  METHODS
  An anonymous internet administered case-based questionnaire was used to survey a sample of healthcare professionals with affiliations to hepatology and transplantation professional societies.
  
  
  RESULTS
  Of 674 completed surveys, the vast majority (93%) of the respondents were physicians, surgeons or allied transplant professionals actively caring for liver transplant patients and 81% practiced in the US. A strong majority believed procurement practices were ethically sound in the US and Europe (87% and 73%) but fare fewer believed that procurement practices were ethically sound in China (4%, p < 0.001). In case-based questions, lack of confidence in the ethical standards of organ procurement in China predicted patient-care decisions. The majority would provide post-transplantation care for patients who underwent liver transplantation at another domestic center, in a foreign country and in China (90%, 78%, and 63%, respectively, p < 0.001) yet respondents who suspected unethical procurement practices in China were more reluctant to do so (p < 0.001).
  
  
  CONCLUSIONS
  Transplant professionals expressed concern about organ procurement practices in China which influenced their patient-care decision-making.
authors.affiliation: Gastroenterology Heath Outcomes Policy and Economics Research Program, University of California San Francisco, San Francisco, CA 94143-0538, USA. Scott.Biggins@UCSF.edu
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.forename: Kiran
authors.initials: K
authors.lastname: Bambha
authors.forename: Norah
authors.initials: N
authors.lastname: Terrault
authors.forename: John
authors.initials: J
authors.lastname: Inadomi
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.forename: Nathan
authors.initials: N
authors.lastname: Bass
mesh_terms: D001291:Attitude of Health Personnel; D002681:China; D002983:Clinical Competence; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000941:ethics* / Q000706:statistics & numerical data; D008297:Male; D057193:Medical Tourism / Q000941:ethics*; D008875:Middle Aged; D010353:Patient Education as Topic; D011159:Population Surveillance; D014019:Tissue Donors / Q000941:ethics / Q000523:psychology / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000941:ethics*