George Archer, at the age of 78, travelled to Lahore, Pakistan, in May, 2006, for a kidney transplant. Three weeks later he came home to Montreal, jubilant, with the kidney of a 22-year-old man. But jubilation would soon turn to pain and regret.
Mr. Archer had been desperate for a new kidney. Since his kidneys had failed in the spring of 2004, his life depended on dialysis.
"He felt stuck. There was that desperation," said his daughter, Ann Archer.
Ms. Archer saw pictures of the hospital in Lahore where her father's operation took place.
"It looked okay but not what we are used to," she said.
A few weeks after Mr. Archer returned from Pakistan, his transplant incision, which had been leaking slightly, split open. While treating him, doctors in Montreal discovered other health problems: respiratory distress, heart beat irregularity and atherosclerosis.
Ms. Archer travelled to Montreal from her Ottawa home in June to see her father and was shocked to find him bedridden, with laboured breathing and little muscle mass. He died two days later.
"I wasn't expecting that," she said.
Along with grief, Ms. Archer is feeling discomfort over the fact that her father bought a kidney in a foreign country.
"The donor was a young man who is down to one kidney. It upsets me. It's disturbing, the harvesting of organs."
Mr. Archer, fighting for his life, was part of a worldwide trend dubbed "transplant tourism." Studies have emerged that show this practice is often unethical and risky for both recipients and donors. Still, Canadians unwilling or unable to wait for a transplant at home are part of the transplant tourism trade.
Canadian doctor Jagbir Gill, while working as a postdoctoral research scholar at the University of California at Los Angeles, was involved in a study comparing outcomes of kidney transplant recipients who travelled overseas with those who stayed at UCLA. After one year, the rate of kidney rejection was 30 per cent in transplant tourists and 12 per cent in those operated on at home.
"In some cases, patients returned in good health and excellent kidney function," said Dr. Gill, who is back in Canada and working as a transplant nephrologist at St. Paul's Hospital in Vancouver.
"On the other extreme," he said, "patients presented directly from the airport to the emergency room requiring urgent admission to hospital with severe infections or kidney failure."
Dr. Gill described the worst-case scenario encountered in the study: One patient who contracted hepatitis from an organ donor returned to the United States to discover she required a repeat kidney transplant as well as a liver transplant.
"Both of these transplants failed and she died within two years of obtaining her transplant and after having spent over 20 months in hospital." The study is published in the November, 2008, issue of the Clinical Journal of the American Society of Nephrology.
The Canadian experience is similar. Two years ago, Jeffrey Zaltzman and colleagues at the renal transplant clinic at St. Michael's Hospital in Toronto studied Canadians who had travelled overseas for an organ transplant and returned to the hospital. That study revealed greater risk of infection and higher rates of rejection and death.
"They sometimes get off the plane very sick and go straight to [emergency]," Dr. Zaltzman said. "They bring back infections that are endemic to the area where the transplant was done. These can be resistant to many of the drugs here."
While going overseas for a transplant can be risky, it also raises the question: Who is providing the body parts? It has been widely reported that in China, after execution, political prisoners' organs were harvested. But Dr. Zaltzman believes this practice was curtailed before the Olympics because of worldwide pressure.
