ROTTERDAM China and Pakistan, leaders in worldwide "transplant tourism," are bowing to outside pressure and cracking down on trafficking in human kidneys taken from executed prisoners and the poor, experts said on Wednesday.
New laws in both countries, where rich foreign patients could pay large sums to get kidney transplants unavailable at home, are starting to hamper this illegal trade that makes up about 10 percent of all kidney transplants worldwide, they said.
Kidney failure is increasingly common in rich countries, often because of obesity or hypertension, but a growing shortage of transplant organs has fuelled a black market that exploits needy donors and risks undermining voluntary donation schemes.
"This is an enormous step forward," Luc Noel of the World Health Organization (WHO) told Reuters at a conference on coordinating European policies for organ transplants.
"Transplant tourism is far from being finished. But there is now a realization that this is exploitation," he said, adding transplants with kidneys from impoverished donors were still common in Egypt, the Philippines and other poor countries.
Trade in human organs is illegal in Western countries but the fast rising demand for kidneys has led to calls -- mostly from the United States -- to allow a regulated market for them.
Most doctors, hospital administrators and medical ethicists at the conference rejected the idea as unethical and a threat to existing systems for voluntary donations. They also called on health insurance systems not to reimburse "transplant tourists."
Noel said China approved in March a draft law for clearer guidelines on legal transplants. It had begun limiting "transplant tourism" last year after charges by human rights groups -- which it denied -- that it used organs from executed prisoners.
Pakistan has had no law allowing organ donations from the deceased -- a major source of replacement organs -- but its cabinet approved a draft transplantation law in February that still requires parliamentary approval.
Some commentators link Beijing's change in policy to a concern for its image before it hosts the Olympics in 2008.
Annika Tibell, head of the ethics committee of the worldwide Transplantation Society, said Chinese doctors who used organs from prisoners were banned from joining her group or attending seminars where they could learn new surgical techniques.
Noel said the tightening up in China had had "a domino effect" in countries that depended on transplant tourism to solve the problem of increasing kidney failure.
South Korea, which used to depend on China for kidneys, was reassessing its policies now that Beijing is closing the door on foreign patients. Saudi Arabia, which sends about 700 patients abroad annually, was also rethinking, he said.
According to Norbert Lameire of the International Society of Nephrology, the United Arab Emirates sends its kidney patients to the Philippines for transplants. The health insurance takes care of the $95,000 fees, $10,000 of which go to the donor.
Noel said India, which over a decade ago was "the kidney bazaar of the world," cracked down on its "transplant tourism" dramatically in 1995 but an internal black market still exists.
According to WHO estimates, China hosted almost 2,000 "transplant tourists" in recent years, using mostly kidneys from executed prisoners. Pakistan hosted up to 1,500, the Philippines had up to 200 operations and Egypt 100.