Section 18. Professional framework for liver transplantation for overseas patients: traveling for living donor liver transplantation.
BACKGROUND
Liver transplantation (LT) in overseas patients is a sensitive issue because of the possibility of organ trafficking and transplant tourism. In the Istanbul Summit, there was a call to develop standardized professional frameworks to prevent these practices.


OBJECTIVE
Our objectives are three-fold, to critically evaluate our professional framework, to study the demographic profiles, and to identify the outcome and impact of LT in overseas patients.


METHODS
Recipient and donor case records, e-mail communications, and medico-legal records were collected and analyzed for management strategy, demographic profile, donor and recipient characteristics, and outcome.


RESULTS
Only 5% of our total LT operations were for overseas patients. Forty-two (79%) were pediatric cases for which 39 (93%) were due to biliary atresia (P<0.001). Sixty-eight percent were from the Philippines. Thirty-seven (70%) of the donors were first-degree relative. The average hospital days of a pediatric living donor liver transplant (LDLT) recipient was 65.48±28.7, and average cost was 44,602 USD. An adult LDLT recipient stayed for 52.09±11.3 days and spent around 75, 013 USD. A donor of pediatric LDLT stayed in the hospital for 17.42±5 days and spent round 8,176 USD. A donor for adult LDLT was admitted for 15.5±4 days and spent an average 9,612 USD. The total cost for recipient and donor were 56,615 USD (range, 28,976-82,056) for pediatric LDLT and 84,483 USD (range, 64,851-108,467) for adult LDLT. Actuarial survival rates were 91% at 1 year, 88% at 3 years, and 86% at 5 years and 10 years.


CONCLUSIONS
Travelling for LDLT may be a wise and cost-effective step for patients with end-stage liver disease seeking alternative ways from their country. Our professional framework is effective to prevent practice of organ trafficking and transplant tourism. It may be useful to develop international guidelines for the practice of LT in overseas patients.
1 Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 2 Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 3 Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 4 Address correspondence to: Chao-Long Chen, M.D., Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan.
Catherine S
CS
Kabiling
Chao-Long
CL
Chen
Allan
A
Concejero
Chih-Chi
CC
Wang
Shih-Ho
SH
Wang
Chih-Che
CC
Lin
Yueh-Wei
YW
Liu
Chee-Chien
CC
Yong
Bruno
B
Jawan
Yu-Fan
YF
Cheng
D000328:Adult; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality / Q000592:standards; D019520:Living Donors; D008297:Male; D057193:Medical Tourism / Q000191:economics; D008875:Middle Aged; D015996:Survival Rate; D013624:Taiwan; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome