Adelstein did not pursue the story but mentioned the incident in a recent opinion piece in the Washington Post. He said he would elaborate on it in a forthcoming book.
Dealing with scandals
Word of the surgeries at UCLA comes as the U.S. transplant system is slowly recovering from scandals that forced the closure of three transplant programs in California. In one of those, St. Vincent Medical Center in Los Angeles moved a Saudi national up a liver waiting list, bypassing dozens of others, and then covered it up by falsifying paperwork, officials there have acknowledged.
Overseers of the U.S. transplant system say they are unaware of other cases in which hospitals have provided organs to foreign criminals. But some hospitals, including Stanford University Medical Center, have performed transplants on U.S. prisoners -- often controversial because taxpayers foot the bill.
According to the ethics committee of the United Network for Organ Sharing, "one's status as a prisoner should not preclude them from consideration for a transplant."
The network encourages transplant programs to give foreign recipients less than 5% of organs from deceased donors each year, but that is not a hard-and-fast rule. At one point, in the 1980s, the threshold was 10%, but it was lowered after Congress considered banning transplants for foreign nationals entirely.
Centers that exceed the 5% guideline are asked for an explanation in writing, but none has been sanctioned publicly. In 2001, the year Goto received his transplant, UCLA slightly exceeded the guideline.
Typically, transplant experts say, foreigners cannot receive transplants at U.S. centers unless they are willing to pay the full cost of the procedure out of pocket -- without the substantial discounts given to insurers. Charges for a liver transplant and immediate follow-up care generally exceed $523,000, according to an April report by Milliman Inc., an actuarial firm.
It could not be determined how much UCLA and Busuttil were paid for the Japanese transplants.
Tom Mone, chief executive of OneLegacy, the group responsible for procuring and distributing organs in much of Southern California, said transplants for foreign criminals are "an unfortunate result of a system that's magnanimous to the world."
Mone also said hospitals do not have the resources to investigate their patients. "The enforcement should be at the borders, not at the hospital," he said.
In recent years, nonresident foreign nationals have accounted for less than 1% of all transplant recipients nationwide, transplant statistics show.
Dr. Mark Fox, associate director of the Oklahoma Bioethics Center, said the UCLA transplants may create pressure to eliminate transplants for foreign nationals entirely, which Fox said he does not support.
"For some people, there are misgivings for transplanting foreign nationals at all. For some people, there are misgivings about transplanting criminals at all," he said. "When you put those two together, it is certainly reasonable to expect that a certain portion of the population would say, 'This is not what I expected when I signed my donor card.' "
The Times' Tokyo bureau and staff writer Teresa Watanabe in Los Angeles contributed to this report.
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