Ethnocentrism Is an Unacceptable Rationale for Health Care Policy: A Critique of Transplant Tourism Position Statements

Abstract

Medical tourism has emerged as a global health care phenomenon, valued at $60 billion worldwide in 2006. Transplant tourism, unlike other more benign forms of medical tourism, has become a flashpoint within the transplant community, underscoring the uneasy relationships among science, religion, politics, ethics and international health care policies concerning the commercialization of transplantation. Numerous professional associations have drafted or issued position statements condemning transplant tourism. Often the criticism is misdirected. The real issue concerns both the source and circumstances surrounding the procurement of donor organs, including commercialization. Unfortunately, many of the position statements circulated to date represent an ethnocentric and decidedly western view of transplantation. As such, the merits of culturally insensitive policy statements issued by otherwise well-intended transplant professionals, and the organizations they represent, must be evaluated within the broader context of foreign relations and diplomacy, as well as cultural and ethical relativity. Having done so, many persons may find themselves reluctant to endorse statements that have produced a misleading social desirability bias, which, to a great extent, has impeded more thoughtful and inclusive deliberations on the issues. Therefore, instead of taking an official position on policy matters concerning the commercial aspects of transplantation, international professional associations should offer culturally respectful guidance.

Transplant tourism and organ trafficking

“…The authors found very little research had been completed on the health impact of organ removal on the vendors and suggest that there is little or no medical follow-up for the donors. [32][33][34] The concept of informed consent is integral to an individual's self-determination and participation in wellness. Katz 35 asserts that informed consent is important because the patient must understand the variety of options available to him or her, and the healthcare profession has a moral imperative to help the patient understand the benefits and the harm that may come from his or her choices.…”

Re-conceptualizing the organ trade: separating “trafficking” from “trade” and the implications for law and policy

“…Countries differ in their local, cultural, and socio-political circumstances which can inhibit the adoption of a "one size fits all" punitive response imposed through a Western design [52]. Examples of alternative, harmreductionist strategies could involve not only the removal of punishments for sellers, but also of buyers and whistle-blowers, and enhancing their protection.…”

Seeking Health Care Through International Medical Tourism

“…Although, medical tourists often take advantage of vacation activities, their primary objective is healthcare (Bookman & Bookman, ). Evans () reports medical tourism in 2006 was a $60 billion industry worldwide.…”

“…Lower healthcare cost is commonly cited as motivation for medical tourism, with patients finding a 40% to 90% savings in the international healthcare market for comparable procedures (Bookman & Bookman, ; Burkett, ; Merrell et al, ). Medical tourists also travel to avoid wait times for elective procedures in their countries of origin (Evans, ; Leahy, ). The ability to obtain new or experimental treatments not obtainable within the country of residence may also motivate medical tourists (Blythe & Farrand, ; Lindvall & Hyun, ; Spar, ).…”