In the past, the high risk of rejection limited the source of kidneys for transplant to blood relatives or to cadavers whose immunologic characteristics closely matched closely those of the patient. For this reason, transplants posed little or no risk to individuals outside the family of those who had enough resources to afford the procedure. Ethical and public health issues were in congruence with kidney disease sufferers’ needs.

The advent of technology that allowed the use of kidneys from living non-related donors changed all that. Effective new methods of suppressing the immune system allowed rich patients to purchase organs from living individuals even if they were not related by blood. This spawned a whole new ethically questionable but global system of commercialized organ donation. In such a system, it was inevitable that the poor would be exploited.

In the Philippines, this exploitation further amplified the already gross inequities in the health sector. Not only was the treatment unavailable to poor Filipinos, they would additionally be victimized by commercially minded predators (including unethical medical practitioners) who convinced them to part with their kidneys for paltry sums (the present going rate is much less than 200 thousand pesos).

In 1999, following an expose by news media, the Department of Health banned the practice and created a committee to study implications of allowing kidney transplants from living non-related donors (LNRD). In 2002, the Department lifted the ban and allowed the procedure under ethical guidelines to be implemented by a National Transplant Ethics Committee (NTEC) through a system of Hospital Ethics Committees.

Early in 2007, the NTEC chairperson resigned citing the continued inaction of the DOH in implementing sanctions amid the growing evidence of ethical transgressions by some hospitals with growing foreign clientele for their kidney transplant teams. Soon after, the DOH initiated activities aimed at revising the existing issuances on transplants – ostensibly to improve regulation and reduce practices that were not only unethical but also violated public health principles.

Concerned individuals comprising professionals involved in kidney care, public health practitioners (in and out of government), ethicists, and others convened in a forum to review ethical considerations of renal transplantation at the Medical City Medical Center in Mandaluyong City in June of 2007.

The forum confirmed that certain hospitals had not conformed with the agreed existing guideline – particularly the provision limiting the performance of kidney transplants on foreign patients at each facility to 10 percent of total transplants performed therein. Available figures on the percentage of transplantation for foreigners at that time showed the following rates at specified hospitals: Capitol Medical Center 82 percent, St. Luke’s Hospital 31 percent, Far Eastern University-Nicanor Reyes Medical Foundation Hospital 42 percent, V.R. Potenciano Memorial Medical Center 100 percent, World Citi 77 percent, V. Sotto Memorial Medical Center (Cebu City) 25 percent.

Last week, after almost a year of hearings and discussion, the Department of Health issued Administrative Order No. 2008 Series 0004 on the subject of "Revised National Policy on Kidney Transplantation from Living Non-related Organ Donor and its Implementation Structures." In statements to the press, the department claimed that this new issuance would eliminate commercialized kidney donations. Indeed, two of the AO’s general statements say, "payment as precondition for kidney donation and sale and purchase of kidney organs by kidney vendors are strictly prohibited" and "all health and kidney health-related facilities and professionals shall not allow the trade of kidneys."

Unfortunately, the AO contains wording that in effect opens the door to more rampant commercial exploitation of living unrelated kidney donors. This is done by cleverly dividing living non-related kidney donors into two categories namely, directed (the donor specifies the recipient) and non-directed (the recipient is unspecified). Kidneys from non-directed donors are then made available to foreigners by the innocent-sounding statement that "foreign patients may receive organs from local donors subject to the guidelines and limitations formulated for this purpose by the Philippine Network for Donation and Transplantation".

These loopholes were kept in the Administrative Order despite warnings from individual experts and organizations such as the Catholic Bishops Conference of the Philippines, the Philippine Society of Nephrologists, and the World Health Organization. The WHO specifically mentioned the dangers of retaining these two provisions in the order. In addition, the WHO representative pointed out that countries such as China and India had banned kidney transplants for foreigners.

Meanwhile, even as the DOH claims that the guidelines for using LNRD kidneys for foreigners are still in the process of being formulated, the danger remains that kidney tourism in the Philippines will soon be resumed with vigor.