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New DOH chief sparks fears of return of kidney trade

Like dozens of other men in the dusty copra town of Lopez, Quezon, Rommel Villanueva, 30, has a long scar that slices diagonally across the side of his stomach. One can imagine the scar dissolving cinematically into a line on a map that stretches from Quezon province to Israel, Saudi Arabia or any one of the wealthy countries with waiting lists of patients dying for what Rommel once had: a spare healthy kidney.
Kidney donor Rommel Villanueva of Lopez, Quezon said he cannot go back to his construction job because he can no longer lift heavy objects. Candice Montenegro
Now Rommel’s spare is gone, transplanted into a foreigner who could afford the US$60,000 or so package deal for a kidney in the Philippines. Five years later, Rommel is as poor as ever, the P80,000 he was given by the kidney broker long gone, leaving him just the scar and the bitter memory of being ripped off. He also feels he was coerced. After a month of being prepared in Manila for the transplant, like a cow being fattened, he wanted to back out. “Nagastusan na raw ako, hindi na raw pwedeng bumalik, kaya hindi na ako nakauwi sa amin. Parang ayokong magpakuha (I wanted to back out, but they already spent money on my tests so I was not allowed to go home.)," he said. He was promised P100,000, but he left the hospital, the government’s National Kidney and Transplant Institute (NKTI), with only P80,000 and without his kidney, after various deductions that he was never told about. Rommel is only one of several hundred cases of kidney donors documented by government social workers in just three impoverished towns in a remote corner of Quezon province. This high concentration of donors is just the tip of a nationwide iceberg of kidney donations earlier in the decade that led to the World Health Organization (WHO) calling the Philippines a global organ trafficking hot spot, making it to WHO’s ranking of the top five kidney-trading countries in 2007.
The notoriety, coupled with lobbying by doctors opposed to what they deem an unethical practice, led to a ban in 2008 on foreigners flying to the Philippines for kidney transplants. But in recent months, the medical community has been buzzing with talk about a possible lifting of the ban after a statement last July by Health Secretary Dr. Enrique Ona that he was considering a review of the policy imposed by his predecessor, Dr. Francisco Duque. Ona also happens to be one of the country’s pioneering kidney transplant surgeons and was a central figure in the country’s “kidney tourism" at its height from 2005 until the ban took effect in 2008. Hundreds, perhaps thousands, of foreign patients received kidneys from so-called living, non-related donors, usually impoverished men who were not always in the best of health when they gave up their spare kidneys.
Critics say Health Secretary Ona was the 'brains' behind the kidney trade in the Philippines that flourished in the years 2006 and 2007. Candice Montenegro
Those who have studied the kidney trade say that foreigners paid as much as $60,000 to doctors and middlemen for their live-saving transplants. Doctors who oppose the ban on foreign recipients say that transplants are the best way for those suffering kidney failure and needing dialysis to restore their quality of life. Those who support the ban argue that foreigners buy up kidneys that would otherwise go to equally desperate Filipino patients. Before the ban, a 10 percent limit on foreign recipients of Filipino kidneys was blatantly violated. Many doctors also oppose for ethical reasons the trade in body parts, calling it an exploitation of the poor. GMANews.TV obtained a strongly worded letter written to President Noynoy Aquino by the Philippine Society of Nephrology, the national association of kidney specialists, protesting Ona’s appointment. “One of the first pronouncements of the new Secretary of Health, Dr. Enrique Ona, was that he is opposed to a total ban on organ transplants to foreigners…," the doctors’ letter states, “which in effect will reopen the doors to organ trafficking and organ trade in the country." The letter is dated July 9, 2010. Despite repeated requests, Secretary Ona refused to sit down for an interview with GMANews.TV about the issue. His staff said that he does not want to discuss it with the media. However, at an ambush interview at the DOH, Secretary Ona said, “We will review kung ano ang effect noon sa mga pasyenteng nangangailangan. Kasi ang daming mga pasyente ngayon na nangangailangan ng transplant, hindi nakakatanggap, ganoon lang. Of course we don't encourage the so-called sale of organs or trafficking of organs." (We will review what the [ban's] effect has been on patients who need transplants. A lot of [foreign] patients who need transplants cannot be operated on. Of course we don't encourage the so-called sale of organs or trafficking of organs.) As the director of the NKTI from 1998 to 2010, when he was appointed health secretary by President Aquino, Ona performed many of the transplants done at his hospital. According to NKTI hospital records obtained by GMANews.TV, Ona alone charged P144,000 per kidney transplant. The other doctors on his medical team charged substantially less. In 2007, one of the peak years for the trade, transplants by Ona were occurring several times a week. According to recruiters and doctors interviewed by GMANews.TV, transplant surgeons also earned from brokerage fees for matching patients with poor kidney donors like Rommel Villanueva of Lopez, Quezon. NKTI records show that the kidney recipients were charged $11,000 as a payment to the Kidney Foundation of the Philippines, which sources in the medical community say functioned as a brokerage service for foreigners needing new kidneys.
LISTEN TO PODCAST: A kidney trade agent from Quezon province talked to GMANews.TV's Candice Montenegro and revealed that he still recruits men from his community to become kidney donors. He said, "Alam ko naman na mali ito, pero may pangangailangan talaga sa pera, so siguradong may papayag (I know this is wrong, but we need the money so I'm sure there will always be willing donors)."
A kidney agent in Quezon province told GMANews.TV that Filipino doctors connected to global networks would specify to agents, or recruiters, the need for donors, who would then be recruited in impoverished communities, brought to Manila, and then tested for tissue compatibility with the patient. Once compatibility was established, the surgery could take place almost immediately, with the donor back in his community within days, with little prospect of medical follow-ups. US$60,000 package for a Filipino kidney Amihan Abueva, executive director of Asia Acts Against Child Trafficking, which has been advocating against human and organ trafficking, said that the $11,000 stated in the hospital records is likely a fraction of the real amount. She said that colleagues of hers in Israel called Israeli recipients of Filipino kidneys who told them that they paid closer to $60,000 for their kidneys, a small price for a wealthy patient who would otherwise be dead now. “Dr. Ona is the brains behind the whole scheme," Abueva said. “Ang nangyari kasi dito sa atin, naging very systematic talaga yung pagkakaroon ng mga ospital at transplant teams na talagang may mga kontrata na sa iba't ibang foreign government, at meron din mga individual brokers na nagdadala ng mga taga ibang bansa para dito sila operahan." (Dr. Ona is the brains behind the whole scheme. Trafficking here became systematic. Hospitals and transplant teams have contracts with foreign governments, and individual brokers bring foreigners here to be operated on.)
ORGAN TRAFFICKING HOTSPOTS Identified by the World Health Organization (WHO) in 2007
(1) China (2) Pakistan (3) Egypt (4) Colombia (5) Philippines
In a letter to the Philippine Daily Inquirer, an NKTI colleague of Dr. Ona, Dr. Romina Danguilan, wrote, “Ona was never engaged in organ trade… NKTI made sure that the donors were properly informed about the procedure, the risks involved, and the medical follow-ups necessary to safeguard their health. This entire program was allowed at that time by the Department of Health." However, other doctors attest that in practice the donor screening and medical follow-ups were not as conscientious. “Sometimes may mga kalagayan silang hindi pala dapat nagbigay sila ng kidney (Sometimes they have conditions that should prohibit them from donating their kidney)," said Dr. Irma Gueco of the Philippine Society of Nephrology, in an interview. Gueco and her colleagues in the society of kidney specialists have been checking on impoverished kidney donors in Quezon province for several years. “Dapat ang taong magdo-donate ng kidney, walang high blood pressure, walang urinary tract infection... Of course yung doctor na tumingin hindi siguro alam na mataas na yung blood pressure nila because they were being given medication. So after that, wala namang nagfo-follow up sa kanila." (Kidney donors should not have high-blood pressure, no urinary tract infection. Of course, the doctors who examined them may not have known about the blood pressure because of medication. After the transplant, no one followed them up.)
Rommel, the kidney donor from Lopez, Quezon, recalls, “Wala namang doktor na pumunta sa amin nung matapos yung operasyon. Basta yung mga bantay lang namin, ang bantay yung ahente (Only the agent stayed with us in the hospital. No doctor checked up on us)." “Pag ika'y may na-reject lang nang konti, painumin ka lang nila ng gamot, pwede ka pa rin operahan, (If you're rejected, they will make you drink medicine and they will still operate on you)" adds the kidney donor who is based in Quezon province. Among the NKTI documents obtained by GMANews.TV was a list of foreign patients undergoing procedures essential for receiving a kidney transplant. The tests all took place in 2009, after the ban on foreign recipients took effect in 2008. Out of 27 patients, 12 were listed as having Dr. Ona as their attending physician. NKTI sources say that undergoing the tests was not proof that the patients actually received local kidneys or that there was any violation of the ban by the NKTI or the attending physicians. But other doctors who have seen the list say there could be no other reason to undergo the tests if the patients were not being prepared to receive a kidney in the Philippines. When asked about the foreign patients, Ona said, “Kung meron man, those are patients that have been cleared by the ethics committee. Ibig sabihin you have to look at the individual case." Ona was referring to the National Transplant Ethics Committee, which authorized exemptions for foreign patients already on the kidney waiting list when the ban on foreign recipients was imposed in March 2008. Before the 2008 ban, there had been a 10 percent limit on foreigners receiving Filipino kidneys. But that limit was grossly violated, as many in the medical community attest, including Dr. Ona himself, one of the leading transplant surgeons at the time. As the then-president of the Philippines Society for Transplant Surgeons, Dr. Ona admitted to then Health Secretary Francisco Duque in a February 29, 2008 letter that “there have been serious lapses on our part in the implementation of the 10% limit on foreign recipients as espoused by the current guidelines." In the letter, Ona vowed that he and other surgeons would go on a “self-imposed moratorium for foreign living non-related kidney transplants" until new guidelines were in place. The admission and voluntary action took place during government deliberations of a total ban on foreign recipients. Several weeks later, the Arroyo administration issued the ban order anyway, ending the heyday of kidney trafficking in the Philippines. Now in Duque’s shoes, Health Secretary Ona wants the ban reviewed and possibly lifted. - Multimedia and additional reporting by Candice Montenegro, GMANews.TV