Commercial organ transplantation in the Philippines.

Countries throughout Asia promote themselves as leading destinations for international travelers seeking inexpensive healthcare. India, Indonesia, Malaysia, Singapore, the Philippines, and Thailand are all trying to attract greater numbers of what their promotional campaigns call ‘‘medical tourists.’’ Government tourism initiatives, hospital associations, medical tourism companies, and individual hospitals advertise hip and knee replacements, spinal surgery, cosmetic surgery, and other medical procedures. In contrast to most nations marketing treatments to international patients, the Philippines differentiates itself by selling ‘‘all inclusive’’ kidney transplant packages. Patients from other countries travel to the Philippines and receive kidneys purchased from poor individuals. The Philippines’ market in kidney transplants is connected to widespread poverty in urban slums and outlying rural areas. Organ brokers target inhabitants of poor communities. Although trafficking in persons and organ brokering is illegal in the Philippines, the country’s trade in kidney transplants is well known and attracts only sporadic attention from local law enforcement agencies. Within the United States, nearly 105,000 individuals are wait-listed for organ transplants. Of this population, more than 78,000 patients need kidney transplants. The gulf between the number of individuals requiring renal transplants and the number of kidneys available for transplantation is large and growing. Public awareness campaigns promoting organ donation, increased use of kidneys from living-related and living-unrelated donors, and expanded criteria for use of kidneys procured from deceased donors have not closed the gap between supply and demand. Other countries face a similar gulf between demand for organs and supply of organ transplants. In response to the scarcity of organs available for transplantation, underground economies or ‘‘black markets’’ have emerged in several countries. Organ brokers connect international patients with sufficient funds to poor individuals willing to exchange kidneys for cash. Persons engaging in commercial organ transplantation have purchased organs in such countries as India, Pakistan, the Philippines, and China. In China, organs were taken from executed prisoners. Hearts, livers, lungs, and kidneys were all advertised on Internet sites and sold to international patients. In most other countries where commercial transplants are available, kidneys are bought from living providers. Due to changes in legislation and regulatory enforcement, it is now much more difficult for foreign patients to purchase kidneys in China and several other jurisdictions where commercial sales of organs occurred. Pakistan and