title: Interviews With Patients Who Traveled From Macedonia/Kosovo, The Netherlands, and Sweden for Paid Kidney Transplantations.
abstract: BACKGROUND
  Patients travel worldwide for paid kidney transplants. Although transplantations abroad are not always illegal, they are commonly perceived to be illegal and unethical involving risks.
  
  
  OBJECTIVE
  We aimed to describe the motivations and experiences of patients who traveled abroad for paid kidney transplantations and to examine how these transplantations were facilitated.
  
  
  METHODS
  We interviewed 22 patients who traveled from Macedonia/Kosovo, the Netherlands, and Sweden for paid kidney transplantations between years 2000 and 2009.
  
  
  RESULTS
  Patients traveled because of inadequate transplant activity in their domestic countries and dialysis-related complaints. However, 6 patients underwent preemptive transplantations. Cultural factors such as patients' affinity with destination countries, feelings of being discriminated against by the health-care system, and family ties also help explain why patients travel abroad. Seven of the 22 patients went to their country of origin. They were able to organize their transplantations by arranging help from family and friends abroad who provided contacts of caregivers there and who helped cover the costs of their transplants. The costs varied from €5000 to €45 000 (US$6800-US$61 200). Seven patients paid the hospital, 5 paid their doctor, 4 paid a broker, and 6 paid their donors.
  
  
  CONCLUSIONS
  Research should include interviews with brokers, transplant professionals, and other facilitators to achieve a full picture of illegally performed transplantations.
authors.affiliation: 1 Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: van Balen
authors.affiliation: 1 Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands.
authors.forename: Frederike
authors.initials: F
authors.lastname: Ambagtsheer
authors.affiliation: 2 University of St Cyril and Methodius, Medical Faculty Skopje, Republic of Macedonia.
authors.forename: N
authors.initials: N
authors.lastname: Ivanovski
authors.affiliation: 1 Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Weimar
mesh_terms: D006801:Humans; D016030:Kidney Transplantation; D063826:Kosovo; D057193:Medical Tourism; D009426:Netherlands; D018843:Republic of North Macedonia; D013548:Sweden
keywords: interview; kidney transplantation; medical tourism; organ trafficking