The role of humanitarian education within the educational system of future doctors and healthcare professionals can’t be overestimated. At the same time, teachers of clinical specialties are short of time to discuss humanitarian issues, whereas for those who teach humanitarian specialties it is difficult to find time for discussion of medical issues. So, when offering courses of humanitarian education at medical schools, it is necessary to use the existing capacity of thematic structuring of the education in the field of medical humanities in a more fruitful way. Bioethics — a humanitarian discipline integrating clinical, humanitarian and even scientific knowledge — is a highly successful time-tested educational tool [1, 2].

Sustainable models and trends evolved while teaching bioethics at Russian medical universities. Thus, a large amount of pressing humanitarian issues typical of modern healthcare is left beyond the educational scope of the discipline and outside the attention of future doctors. According to a recent study, medical tourism is one of these issues. It occurred due to the growing involvement of our fellow citizens into the global healthcare and industry of medical tourism [3].

Transplant tourism is an integral part of the problems associated with the development of medical tourism. Owing to the related negative connotation, the issue almost left the courses in bioethics or joined the marginal issues. The phenomenon itself has not gone anywhere. On the contrary, it can turn into a serious challenge of Russian healthcare that a new generation of medical graduates can’t be ready for both in professional, ethical and mental terms.

The issue of transplant tourism is given little attention in terms of scientific discussion held by Russian specialists in medical humanitaristics. In the available publications, the focus is primarily on the foreign experience of withstanding transplant tourism, whereas the suggested recommendations concerning the existing problem are still rather preliminary and not convincing enough [4, 5]. In particular, a trial offered to concentrate on two aspects of work such as better control over the transnational mechanisms of transplantation of organs (by using the Unified registry of transplanted organs) and carrying out information and explanatory work among population displaying gratuitousness of organ donation in our country and a lack of channels donating organs of Russian citizens to other countries [4]. Insufficiency of the suggested recommendations can be admitted due to the circumstances described below.

Rapidly developed medical technologies has turned transplantation of all vital organs such as kidneys, liver, heart and lungs into a routine procedure since the XX century. This resulted in a shortage of donor organs in any country where transplant medicine was developed. National healthcare systems make enormous efforts to deal with the problem. The efforts are carefully analyzed by the scientific community [6]. Moreover, there have been significant advances in Europe concerning the overcoming a shortage of organs at the transnational level due to high integration of medical services [7, 8]. Nevertheless, in spite of significant progress in the elimination of a shortage of organs at the national and transnational (European) level, the shortage of donor organs is still an unfixable issue. The problem can be seen in Russia as well, as here the level of satisfaction of people’s needs in transplantation surgeries is 10%. Meanwhile, in Russia, the level of donor activity used to describe the scope of organs suggested for transplantation is one of the lowest in Europe (4.5 per million of people in 2018 and 2021, according to annual reports of the Russian transplantology society and Newletter transplant published under the authority of the Council of Europe [9, 10].

Poor provision of Russian transplantation centers with donor organs is a real problem for our healthcare, which can’t be solved yet in spite of all efforts of Russian professionals. In Russia, the highest donor activity has been noticed in Moscow only (23.7 per million people according to the results of 2021). 12 transplantation centers are found in Moscow and the Moscow region; the majority of transplantations is performed here [9]. Such a medical and organizational disproportion creates objective prerequisites to encourage the practice of transplant tourism among our citizens who can refer to foreign hospitals to deal with their health-related issues.

The Istanbul Declaration adopted in 2008 and signed by Russia calls on all countries to withstand such phenomena as trading organs and transplant tourism, concentrate on being self-sufficient regarding donor organs and overcome distrust and barriers that prevent from effective cadaveric donation being developed [11]. Implementation of ethical principles established herein is not possible without a developed infrastructure of transplantation medicine under national jurisdiction. Russia is a very big country, and creating such an infrastructure in the nearest future is a serious challenge.

The studies performed in 2010 have shown that the Russian society has seen a rather high level of ‘mortal fears’ because citizens and opinion leaders were poorly familiar with the issues associated with the practice of donation and transplantation of organs [12, 13]. The reason for that was the idea that donor organs from Russia go abroad and are used in the interests of foreigners. Meanwhile, such a situation — limited even then — could arise in the 1990-s only in the conditions of administrative and bureaucratic chaos. On the contrary, another trend was noticed in 2010. Russians increasingly went abroad for the purpose of transplant tourism. Academician Gautier SV, the principal transplantologist of the Ministry of Health of the Russian Federation, brought this into view in due time. In his opinion, when some our citizens come across long waiting lists at Russian transplantology centers, they risk to undergo organ transplantation abroad (for instance, in Pakistan) [14].

Pakistan and other countries of Southern Asia have earned the reputation of ‘the international bazaar of organs’ in the 2000s. They are known for an excessive amount of donor organs, unlike the Anglo-Saxons, Europe and Latin America that faced a shortage of these. The excess is due to chronic poverty of the locals and developed transplantology centers that provide service in the field of medical tourism and are located nearby.

In India, Apollo hospitals offer transplantology services with information on their website used to be translated in Russian as well [15]. The role of India as one of the principal global centers of transplantation tourism is changing gradually. The Indian government tries to free their country from the embarrassing image of ‘organ bazaar’ and market of surrogate maternity [16]. However, according to some trials, highly corrupted healthcare and remaining loopholes in the legislation hamper the attempts seriously [17, 18].

China is another global center for transplant tourism. According to western experts, organs are taken from the bodies of executed criminals there [19, 20]. Unlike India that started providing official statistics on donorship and transplantology for European observers since 2019 [10], the government of China traditionally avoids the practice and demands to respect its healthcare approaches. Though western authors provide extensive data about systematic human right violation in the field of organ donation in China, a large part of these publications should be interpreted with caution. The reason is the ridiculous accusation of cannibalism in China published in the Western media some time ago in the context of blood and organ donation [21].

Recognizing the general remaining uncertainty of provision of services in the field of transplant tourism in India, China and some other Asian countries, it should be admitted that possibilities of rendering the services to our citizens remain significant. This is precisely what is meant by Academician Gautier SV when it comes to these cases.

In medical aspect, the danger is that having received a donor organ abroad, Russian patients return to our country and create an excessive load for the healthcare system as no quotas have been allocated to them by the state and no costly immunosuppressive agents have been purchased for their subsequent treatment. When the patients come back, they have serious complications. Emergency measures have to be taken to save the patients, and doctors fail to give attention to planned patients [14]. However, some other aspects are identified. Travelling abroad to receive an organ makes our citizens to contact with unscrupulous intermediaries. Ignorance of local laws results in the risk to spend time and money without solving the basic issue. Besides, attempts to pay for everything do not allow to value someone’s health and life leading to exaggerated claims to others at home.

Such a significant humanitarian issue as transplant tourism is still beyond public attention and is not the subject of intense discussions among our specialists. However, new evidence requiring careful scrutiny have been accumulating. It appears that this topic should be provided proper attention in the course of bioethics taught to those obtaining modern medical education and as part of discussion of ethical issues that accompany the development of transplantology.