He is said to be a surgeon who removed kidneys from unwilling poor Indian laborers for transplantation to rich patients in kidney failure - mostly from outside India. The large number of websites offering renal transplants in Indian medical centers is evidence that commercial kidney transplantation is booming in that country.

This story illustrates one of the adverse effects of globalization of the health care industry. What is worrisome is that it is also taking place in the Philippines with little or no regard for accepted ethical and legal constraints. In fact there is a website that offers living donor kidney transplants in two "medical centers" located in the country.

The site, www.philippines-medical.com, belongs to a company called "Philippine Medical Center, Limited" and lists its address at an office building (Enterprise Tower) on Ayala Avenue in Makati. However it does not identify the "medical centers" involved except to say that each performs approximately 100 transplant procedures annually.

Even as the Department of Health takes its time drafting an Administrative Order to regulate living unrelated kidney donation, this website claims: "The living donor kidney transplant project is sponsored by the government. The Philippine Ministry of Health operates a medical tourism project. Under its sponsorship and supervision, legal organizations in our health centers operate, providing each medical center with living kidney donors for Philippine citizens as well as a quota of living Philippine donors for foreign patients."

The website further proclaims: "Under the supervision of the Ministry of Health, the organization for finding donors, and the medical center, each potential Philippine donor goes through a long series of medical, psychological, and social tests after which an independent board determines the fitness of the donor to donate a kidney.

Once the donor has been found healthy and fit to donate a kidney, the donor's data is entered in a donor database until a patient with the appropriate characteristics and needs a transplant is found. After the transplant is carried out, the Philippine donor is compensated directly by the Ministry of Health. In exchange for his/her donation, the donor will receive medical insurance and additional government support for the donor and his/her family. It is important to note that our all of activities are carried out according to the letter of the law and in strict accordance with all Philippine laws."

The assertions of "Philippine Medical Center, Ltd. on this website, to the knowledge of those who have been participating in the Department of Health's consultations on the issue of living unrelated donor transplantation, are patently false. If only to assure people that DOH is not participating in a covert project to subvert existing and proposed regulations, the Department should look into this. The fact is that there has been a clamor to ban all living unrelated donations of organs and at least one senator has filed bill to do so.

This brings up the broader issue of "medical tourism" and its morality in the context of a country where there exist glaring disparities in health status and access to care between population groups. The case of kidney "donations" from poor uninformed slum dwellers, who themselves have no chance of surviving end stage renal disease if they are unfortunate enough to develop it, is only one of the manifestations of this disparity.

Further, "medical tourism", is a phenomenon that further aggravates the depletion of human resources for health caused by out-migration of health professionals. It diverts resources (both human and material) to cater to the needs of foreign patients, and makes certain that the needs of Filipinos in general (not only the poor) will be further neglected.

Only when the health inequalities within the Philippines have been dealt with, when all the health care needs of its citizens have been met, only then can attending to the health needs of "medical tourists" be justified. To date, only Singapore, among all countries that have active "medical tourism" programs, can justly claim this distinction. The city-state can afford "medical tourism" because its health system has excess capacities after having taken care of its own citizens.

In the case of a commercialized organ procurement program, in addition to the justice issue, morality is further compromised by the fact that, despite claims by those who have vested interests in maintaining this situation, harm is done to those from whom the kidneys are taken. Such harm is disproportionate to the gain of a few pesos for these people whose lives are already miserable from poverty. The procedure also violates their civil rights because this poverty gives them no choice except to accept offers of money.

Hopefully, the concerned institutions and individuals will take all this into account when they examine their consciences on the occasion of the silver anniversary of the National Kidney and Transplant Institute on Feb. 21..

***