By Sue Reid Daily MailWhy are so many foreign patients allowed to come here and take organs donated to the NHS?Looking at her now, it is hard to believe. Exactly four years ago, Elena Maniati was close to death. Her eyes were canary yellow, her skin sallow and her weight down to five stone (70 pounds - 32 kg) - ravaged by liver disease.
Pathetically weak, she struggled to walk more than a hundred yards. Meeting friends was impossible, in case they gave her an infection.
Her flourishing career as an accountant was over and, in the prime of life, all that Elena could do was pray for a miracle.
Yet today she is the picture of health. Sitting in a Greek seaside town, 100 miles from Athens, she is smiling as she explains:
'My life was saved by a liver given to me by one of your people in Britain. The doctors who carried out my transplant are the closest beings to God.'
Elena is alive today thanks to the liver of an anonymous Briton who died in February 2005.
She doesn't know if it was the liver of a man, woman or child, but within hours of their death, it was transplanted into her frail body by surgeons at the Royal Free Hospital in Hampstead, North London.
The operation was a complete success. Elena is back in Greece with her company director husband, Tassos, and working as a government tax official.
However, her case and hundreds of others like it are at the centre of a major international medical debate about the morality of giving organs to foreigners when here are not enough for British patients.
Government ministers recently revealed that 795 organs from British donors have been transplanted into sick foreigners at NHS hospitals over the past ten years.
Hospitals involved in this controversy include London's King's College and the Royal Free, Leeds General Teaching Hospital and London's famous Great Ormond Street Hospital for Children.
The operations are paid for by overseas governments, who have handed over millions of pounds to British hospitals, and by private funds.
The hospitals here welcome this money from abroad. They almost invariably put these foreign patients in private beds and, contentiously, some surgeons have received £20,000 ($28,886 U.S.) for each operation.
Meanwhile, 8,000 very sick British people - nearly 200 of them children - are on NHS lists, waiting for organ transplants which could save their lives. This figure is at an all-time high and campaigners say more donors are desperately needed.
According to Organ Transplant UK, almost 500 Britons died last year while waiting for a transplant, and hundreds more became too ill to undergo the complex surgery.
More than 250 of these individuals need new livers and, tragically, one in five will die before they get a transplant. A further 6,000 are waiting for a kidney, 226 need a lung and 82 require a new heart.
It is not surprising, therefore, that many are questioning why organs from British donors are being given to foreigners while so many British patients wait for transplants - often in vain.
Tory Shadow Minister for Health Stephen O'Brien says: 'This is not about being xenophobic. I am angry this is happening at the cost of British lives. There is a shortage of organs for transplant. We need to ensure they go to patients from this country.'
To counter such criticism, the Government claims that over the same decade, 140 organs from foreigners have been imported to the UK for transplants. However, these are not necessarily allocated to British patients.
Under EU rules, residents of any member country can travel to Britain for medical treatment. If they undergo organ transplants, usually the cost is met by their own health service.
The rules are different for patients outside the EU: they have to pay privately, but are entitled to a donated organ only if it is not suitable for a sick British or EU resident.
It is true that some British patients head overseas for transplants. But these operations are never funded by the Government, are always carried out in desperation and seldom are in an EU country.
Between 2000 and 2007, 170 British patients went abroad for transplant surgery and received foreign organs, mainly kidneys.
Two-thirds went to Pakistan and India, while others travelled to the Philippines, Iran, China and Egypt, where the private sale of organs is rife.
The NHS, however, has warned that this practice is dangerous - a number of patients died after travelling overseas for treatment, and others caught infections during the surgery, including hepatitis C.
What makes matters worse for those British patients waiting for a transplant back home is the fact that hospitals have been told to treat all patients in order of strict
'clinical priority'.
This means that a patient from another EU country can leapfrog a Briton who is less ill when an organ equally suitable for both patients becomes available.
It must be made clear that not all British hospitals equipped with transplant facilities are prepared to go along with this official policy.
Some doctors are so appalled by what they believe to be blatant unfairness against Britons that they are defying the rule and refusing to give organs donated by Britons to foreigners.
Dr Mervyn Davies, a consultant liver specialist at St James' Hospital in Leeds - which does not treat transplant patients from abroad - says: 'There is a shortage of donors, and we cannot cater for the whole of the European Union.'
The Government's own unpublished figures show that over the past two years, 40 Greeks and Cypriots alone have received British organs.
In addition, Libyans, Chinese, Israelis and patients from the United Arab Emirates - all outside the EU - have been given livers, kidneys and hearts donated here.
A critical organ shortage in Greece, Cyprus and many parts of the Middle East means there is a never-ending demand. There is a religious and cultural reluctance in these parts of the world to donate the organs of a dead relative for transplantation.
In Orthodox Christian and Muslim faiths, it is considered a sin to send someone into the next world if their body is not completely whole.
This crisis has been worsened by the high rate of liver problems in these countries.
In Cyprus, for instance, four people every year are discovered to be suffering from hereditary amyloidosis (a deadly complaint provoked by toxins produced by the liver which gradually poison the body). The only cure is a liver transplant.
High rates of hepatitis also affect the populations of Cyprus, Greece, and the Middle East.
Almost 2 per cent of the Greek population is a carrier of the liver disease, which can be inherited or passed on from mother to child during birth. In the most serious cases, a transplant is the only way of saving a sufferer's life.
Few of those foreigners who have received a transplant in Britain are aware of the growing controversy. They are simply grateful to this country and our doctors for their lifesaving treatment.
Typical are Elena Maniati and other Greeks and Cypriots who have travelled to Britain for operations.
The Greek Association of Transplant Patients, an organisation that gives post-operative care, has 287 members. Astonishingly, more than half have been given organs from British donors.
A spokeswoman said there may even be more, because not all those who have received British organs are in her association.
Dr Yannis Boletis, of the Laiko Hospital in Athens and co-ordinator of Greece's foreign transplant programme, says: 'I can understand why Britons feel they are being sidestepped for the sake of foreigners.
'A Greek in Athens would probably have the same grievance if priority was given to an Englishman here.
'However, that is the meaning of the European Union. Here, in Greece, we have too many patients needing transplants. We just cannot cope with the demand.'
His colleague, Dr Efstathios Antoniou, a liver specialist who once worked at Birmingham's Queen Elizabeth Hospital, added: 'Every NHS hospital has private wards and any foreigner has the right to use them.
'It is not our responsibility to say how your hospitals give priority over organs to patients.
'We just know Greek and British patients are on the same waiting lists and have the same chance.'
Panayotis Papoutsis, 68, is one of many who have benefited from Britain's generosity.
In Athens this week, he clasped me by the hand as he told how London's Royal Free Hospital saved his life after he was given tainted blood in Greece during an operation for burns he had suffered during a factory accident.
He subsequently contracted hepatitis C and endured a severe inflammation of the liver.
'I could not even walk up steps because I was so weak. My skin was yellow from the jaundice and though I loved life, I knew I was about to die,' he says.
The only solution was a new liver. 'I asked to be put on the list in Greece - but fewer than 30 liver transplants are carried out each year. There is a shortage of donors because many people are religious and believe that when they die they must go to heaven with all their organs inside them.
'My doctor put my name down on the list in Britain, too. I visited London for tests and was told I was in fifth place at the Royal Free Hospital in Hampstead.'
Mr Papoutsis moved to London and for the next few months lived in a small flat near the hospital while he was prepared for the operation.
'I met people from all over the Middle East and Europe who had come to the Royal Free for organ transplants,' he says.
'Then, eight months after the first tests, I got the call. The doctor said that an organ had been found for me. I had the eight-hour operation the next day.'
The cost of the operation was paid to the private wing of the hospital by Mr Papoutsis' professional engineers' association and the Greek government.
Now, several years later, Mr Papoutsis says: 'I carry part of an Englishman inside me, so I will always feel close to your country.'
Elena Maniati is equally grateful to Britain. She was born a carrier of the virus Hepatitis B, which can gradually inflame and then destroy the liver.
Her health problems flared up when she was 34 during the pregnancy of her first child. She lost the baby and became increasingly ill as her liver failed. She was desperately ill and went to see her doctor in Patras, her home town.
'He grabbed me by the upper arm, which was as thin as my wrist,' she says. 'I had no muscles and he felt just skin and bone. He said: "You must have a liver transplant or you will die." '
The doctor decided to place her name on the Greek waiting list. 'Meanwhile, he begged the British authorities to take me, too,' she says. 'He told me to go to England and wait for an organ to become available at the Royal Free Hospital.
'I lived alone for a year in a flat near the hospital. I was too weak to do much, apart from sew and occasionally pray at the Greek church nearby. I just waited.'
In the late summer of 2004, her hopes were raised when the hospital said they had a liver.
'But it was too fatty, and could not be used,' she says. It was more than six months later, in February 2005, that Elena finally had the transplant - which cost more than £50,000 and was paid for by the Greek government.
When she returned home, her strength gradually improved and she went back to work.
'In September, I received another call,' she says. 'It was from the Greek hospital saying that an organ had become available and I was top of the list.
'Of course, I told them to give it to someone else who needed it. I said I had been to England and had been made well again.'
Stelios Pamboris tells a similar story. He was the first person from Cyprus to go to Britain for an organ transplant, in August 1993.
The postal administrator was in his 30s and suffering from amyloidosis - his damaged liver was poisoning every other organ in his body.
'It was my doctor who suggested that I become a guinea pig and go to England because I was dying and had a young family,' he says.
'I lived there for three months, waiting for a suitable liver to become available at King's College Hospital.'
The operation, paid for by the Cypriot health authorities, was carried out by a team under Professor Nigel Heaton.
'I wasn't scared,' said Mr Pamboris. 'The doctors and staff were so reassuring. I felt in good hands. Afterwards, they wanted to check on me twice a month, so it was a long time before I could go back to Cyprus.
Mr Pamboris, now 58, whose mother and aunt both died of amyloidosis, will always remember King's College Hospital and the doctors who saved his life.
But what of the donor's family who, no doubt, believed that the liver from their dead loved one would go to a fellow Briton?
And what of those British patients waiting for a new liver at the same time who may even have died as a result of not getting it?
How do people like Donna Browne and Stuart Collins - whose one-year- old son Ethan Collins will die within weeks if he does not receive a new liver and intestine - feel about overseas patients taking organs from British donors?
Ethan was born a month premature and needed immediate surgery for an intestinal condition, but doctors were able to save only part of his gut.
He is in Booth Hall children's hospital in Manchester waiting for a donation to become available. His parents have set up a group on the social networking website Facebook, urging people to register as organ donors.
'If I found out that someone from another country had got an organ donation and it could have been my son, I would be very unhappy,' said Donna, from Whitefield near Manchester.
Despite the anger felt by patients' groups, officials at King's College Hospital and the Royal Free have defended their right to treat transplant patients from the EU and say they will continue to do so.
No wonder that people like Stelios Pamboris and Elena Maniati - and the other foreign patients we spoke to this week - say they cannot believe the generosity of this country, or indeed, their luck.
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