One of the most prominent controversies, associated with the realities of a Globalized/post-industrial living, is the rise of a so-called ‘medical tourism’, which is being commonly defined as, “The movement of patients across international borders for medical care that is more expensive or less accessible at home” (Connell, 2011, p. 260).
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The reason why this type of tourism continues to spark public controversies is that it is believed to contribute to the process of Medicare becoming increasingly commercialized, which in turn presupposes the lessened adequacy of healthcare services, provided to those patients that rely on Medicare’s public sector.
Moreover, medical tourism is being commonly referred to as such that contributes to the rise of global socio-economic inequalities, as it results in making high quality healthcare services less accessible to ordinary citizens in the countries where this tourism thrives.
As it was pointed out by Godwin (2004), “Since the care offered by medical corporations (that specialize in medical tourism) is far beyond the reach of even the domestic middle class, leave alone the poor, the beneficiaries can only be the ‘creamy layer’ of the economy which will further worsen the health inequality in the country” (p. 3983).
At the same time, however, the very concept of medical tourism appears being thoroughly consistent with the qualitative essence of Globalization, as a process concerned with the free-market economies’ functioning becoming ever more efficient, which in turn results in more and more people growing to perceive their ability to enjoy healthiness in terms of a commercial commodity.
Nowadays, medical tourism is being increasingly associated with a so-called ‘transplant tourism’, which is being commonly defined as the process of Western patients travelling internationally (most commonly, to the countries of Second and Third World), in order to undergo transplant-surgeries in privately owned clinics.
There are two major contributing factors to the rise of this particular form of medical tourism: the fact that in Western countries, there is an acute shortage of donor-organs, and the fact that undergoing transplant-surgeries abroad often proves to be substantially less expensive.
Just as it is being the case with medical tourism, transplant tourism continues to spark public controversies, due to the fact that, as of today, the concept of transplant tourism is often perceived as being synonymous to the notion of ‘organ trafficking’. According to Budiani-Saberi and Delmonico (2008), “Transplant Tourism has become a connotation for organ trafficking.
The United Network for Organ Sharing (UNOS), recently defined transplant tourism as ‘the purchase of a transplant organ abroad that includes access to an organ while bypassing laws, rules, or processes of any or all countries involved’” (p. 926).
Nevertheless, given the fact that, as time goes on, more and more Western patients express their willingness to become ‘transplant tourists’, it would be only logical, on our part, to discuss transplant tourism in terms of a discursively ambivalent concept, the practical manifestations of which are being equally capable of emanating ‘negativity’, on the one hand, and ‘positivity’, on the other. In my paper, I will aim to substantiate the validity of this thesis at length.
It is now being estimated that in 2007, at least 100.000 Britons sought health care services abroad. The number of Americans that traveled abroad for the same purpose in the year 2008 amounted to 750.000 – while outside of U.S., they have spent on medicinal services close to $2 billion (Reisman, 2010).
According to the same author, “Exports of health services worldwide doubled between 1997 and 2003. They increased worldwide ten times faster than foreign earnings from tourism and five times faster than global exports of services” (p. 3).
Essentially the same dynamics are being observed within the context of what accounts for the qualitative essence of today’s organ-transplantation practices.
For example, according to the statistical information, provided by World Health Organization (WHO), throughout 2005 there have been 66.000 kidneys, 21.000 livers and 6000 hearts transplanted from donors to organ-recipients worldwide, with 10% of transplantation surgeries having been performed on Western ‘transplant tourists’.
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By the year 2010, the percentage of transplantation-surgeries, performed on ‘transplant tourists’, has doubled. (Biggins et al., 2009). As of today, the most popular transplant tourism’s destinations are: Israel, China, India, Phillipines and Pakistan.
In its turn, this can be explained by the fact that in these countries, the functioning of national Medicare systems is being largely deregulated. In its turn, this created a number of prerequisites for the privatized sectors of these systems to grow progressively larger.
And, as it is being the case with the owners of just about any commercial enterprise, the owners of private transplantation-clinics in these countries are being naturally predisposed to regard their businesses’ foremost operational task as such that is being solely concerned with providing them with the opportunity to generate financial profits.
Such an opportunity naturally derives out of the fact that, in the earlier mentioned countries people’s lives continue to drop in value, due to the factor of overpopulation and the factor of the quality of local living standards continuing to diminish.
In its turn, this creates objective preconditions for impoverished locals to consider selling their internal organs for money.
After all, as it was mentioned earlier, the very realities of today’s living naturally cause people to regard their healthiness as nothing short of a commercial commodity, which can be purchased or sold, “Proponents of commercial markets in organ transplants argue that poor individuals should be free to sell kidneys.
They should be ‘at liberty’ to choose between the risks associated with selling a kidney and the risks of keeping two kidneys while remaining impoverished” (Turner, 2009, p. 193).
Given the fact that ordinary citizens (especially the ones from the rural regions) in such countries as China, India, Pakistan or Philippines rarely make more than $5-$10 per day, it makes a perfectly logical sense for them to think about selling their internal organs for money.
After having been paid $15.000 for allowing its kidney to be surgically removed, a particular impoverished Pakistani, for example, will not only have enough money to enjoy a comparative prosperity until the end of its life, but he or she will also be able to provide a financial assistance to its numerous children and relatives.
On their part, Western ‘transplant patients’ are able to benefit from the availability of donor-organs in the Third World countries, as well. This is because this availability naturally causes prices on donor-organs to remain comparatively affordable, “For example, hip replacement surgery, which normally costs around $25,000 in the United States, can be performed for $5,000 in India.
Heart valve replacement surgery, which costs around $200,000 in the United States, costs $10,000 in India” (Sengupta, 2011, p. 312). Nevertheless, it would be quite inappropriate to refer to the rise of transplant tourism as solely the consequence of global inequalities between people in the Second/Third World, on the one hand, and people in the First World, on the other, continuing to become ever more acute.
Apparently, one of the major contributing factor to the growing popularity of transplant tourism is the fact that, as compared to what it is being the case in Western countries, which during the course of last few decades were growing increasingly Socialist, in countries that are being considered the most attractive transplant tourism’s destinations (with the exception China), there are simply no armies of useless but resource-consuming ‘medicinal bureaucrats’ in existence.
In its turn, this significantly simplifies the bureaucratic procedures, concerned with potential donors providing a legal consent for the removal of their internal organs and with surgeons obtaining an official ‘go ahead’ to perform the transplantation surgery on a particular Western patient.
For example, while in their own countries, Western patients are being often required to wait for transplants to become available for as long as 5-10 years. However, while in such countries as China, India or Philippines, they can well expect the required transplantation surgery to be performed on them within a matter of few months, or even weeks (Rhodes & Schiano, 2010).
Thus, there can be few doubts to the fact that, as it was implied in the Introduction, the emergence of transplant tourism was dialectically predetermined by the very course of a historical progress. And, as it has always been the case with just about every newly emerged socio-cultural practice, transplant tourism can be simultaneously discussed in both: positive and negative lights.
The provided earlier background information, in regards to transplant tourism and in regards to what can be considered the foremost motivational factors, behind the process of Western patients deciding in favor of undergoing transplantation surgeries abroad, allows me to outline transplant tourism’s positive and negative aspects as follows:
A. Transplant tourism allows Western middle-class citizens to save considerably on applying for a number of different transplantation operations. For example, in Philippines, Western patients are able to acquire the ‘new kidney’ for as low as $25.000 (Turner, 2009).
Comparing to what are the average prices for kidney transplantation operations in Western countries, this price can be well defined as laughable.
B. Transplant tourism often provides Western patients with the only life-saving opportunity, because by becoming ‘transplant tourists’, they no longer need to wait years and years, before much needed organ-transplantation surgeries are being performed on them.
Given the fact that in Western countries it would prove rather impossible to find individuals who would be willing to trade their internal organs for money, and also the fact that procedures, concerned with obtaining organ-donating consents from the relatives of deceased people are being utterly bureaucratized, it comes as not a particular surprise that many citizens on organ-waiting lists die, even before they get a chance to have transplantation surgeries performed on them.
Yet, for as long as Western patients have the required amount of cash in their pockets, they now have the opportunity to undergo such surgeries in the countries of Third/Second world, without having to deal a number of time-consuming bureaucratic procedures.
Positive/Negative aspects of transplant tourism
A. While abroad, for the purpose of undergoing transplantation surgeries, Western ‘transplant tourists’ can never be 100% guaranteed that donor-organs, which will be transplanted in them, were obtained legally/ethically.
The validity of this statement becomes especially self-evident, in regards to what appear to be the realities of transplant tourism in such countries as China, Philippines or Pakistan, for example. As it was noted by Saberi & Delmonico (2008), “In 2006, 11 000 transplants were performed in China from executed prisoners” (p. 927).
This, of course, represents a big issue for particularly sensitive Western patients. Yet, as practice shows, such their sensitivity disappears rather quickly, once they are being faced with the option of whether to remain moral but dead, or immoral but alive.
B. In countries with traditionally poor hygienic standards, such as Pakistan, China and Philippines, Western patients face the increased risk of having donor-organs rejected by their immune system. The factor of uncleanliness exposes local organ-donors to the particularly acute health-risk, as well.
As it was pointed out by Turner (2009), “When (transplantation) operations are conducted in unhygienic facilities… and when organ sellers return to polluted, hazardous social environments, removal of a kidney puts individuals at increased risk of health problems” (p.194).
In its turn, this explains why Western ‘transplant tourists’ are not being utterly thrilled about the prospect of having to undergo complex surgeries in countries, where the majority of locals do not think that there might be anything wrong about them living in their own filth, in quite literal sense of this word.
One of the most peculiar characteristics of transplant tourism is the fact that, even though that well-established Western physicians tend to refer to it in strongly negative terms, largely on the account of what they perceive as such tourism’s ‘ethical inappropriateness’, it nevertheless becomes progressively popular with more and more Western patients.
This simply could not be otherwise, because as it was mentioned earlier, the functioning of Western Medicare systems has long ago ceased being thoroughly reflective of patients’ actual needs. This is why many of them simply do not have any other choice but to travel abroad, even when such a simple procedure as the replacement of the tooth’s filling is being concerned.
Apparently, it matters very little for Western patients where their health-related problems would be taken care of, for as long as get what they need quickly and for the reasonable price.
We can say that the growing popularity of transplant tourism provides yet additional confirmation to the conceptual validity of the foremost theoretical principle, upon which the free-market economy’s proper functioning is being based – for as long as there is a demand, there will always be a proposition.
Therefore, it will only be logical, on my part, to conclude this paper by suggesting that, in the very near future transplant tourism will attain a fully legitimate discursive status. I believe that this conclusion is being thoroughly consistent with the paper’s initial thesis.
Biggins, S. et al. (2009). Transplant tourism to China: The impact on domestic patient-care decisions. Clinical Transplantation. 23 (6), 831-838.
Budiani-Saberi, B. & Delmonico, F. (2008). Organ trafficking and transplant tourism: A commentary on the global realities. American Journal of Transplantation, 8, 925-929.
Connell, J. (2011). A new inequality? Privatization, urban bias, migration and medical tourism. Asia Pacific Viewpoint, 52 (3), 260-271.
Godwin, S. (2004). Medical tourism: Subsidizing the rich. Economic and Political Weekly, 39 (36), 3981-3983.
Rhodes, R. & Schiano, D. (2010). The dilemma and reality of transplant tourism: An ethical perspective for liver transplant programs. Liver Transplantation, 16 (2), 113-117.
Reisman, D. (2010). Health tourism: Social welfare through international trade. Northampton, U.S. Edward Elgar Publishing.
Sengupta, A. (2011). Medical tourism: Reverse subsidy for the elite. Signs: Journal of Women in Culture & Society, 36 (2), 312-319.
Turner, L. (2009). Commercial organ transplantation in the Philippines. Cambridge Quarterly of Healthcare Ethics Journal. 18 (2), 192-196.