Thursday, September 7, 2017

U.S. transplant patients from overseas

Here's a paper presented at the ISODP meeting in Geneva, concerning which foreign patients receive deceased-donor organs in the U.S.   Bottom line, there are fewer than 1% of transplants going to foreign patients.  Half of them go to patients from Saudi Arabia and Kuwait.
Transplant Tourism into the United States
Francis L. Delmonico1, Timothy Pruett2, Gabriel M. Danovitch3, Nancy L. Ascher4.
1Chief Medical Officer, New England Donor Services, Waltham, MA, United States; 2Chief Division of Transplantation, University of Minnesota, Minneapolis, MN, United States; 3Department of Nephrology, University of California Los Angeles, Los Angeles, CA, United States; 4Division of Transplant Surgery, University of California San Francisco, San Francisco, CA, United States
Introduction: Since 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the country residence of every patient undergoing transplantation in the United States. This policy replaced the quota 5% limit of non-US citizen/non-residents (NC/NR) traveling to the US for the purpose of transplantation.
Methods: Since April 1, 2015 the country of residence for the NC/NR on the wait list has also been recorded. The citizenship data of the candidate listed for transplantation was obtained from the Transplant Center Registrations (TCR) forms. These data excluded registrations of patients removed the wait list following living donor transplantation.
Results: Between April 1, 2015 and May 31, 2016, there were 42,754 waitlist additions for kidney transplantation, 551 of whom were NC/NR. Of the 14,394 waitlist additions for liver transplantation there were 191 NC/NR. The most NC/NR registrations for kidney and liver combined were from Saudi Arabia (70 total, 15 kidney and 55 liver) and Kuwait (37 total, 15 kidney and 22 liver).
Of the 14,798 kidney transplants performed from deceased organ donors there were 163 NC/NR. Of the 8168 liver transplants performed from deceased organ donors there were 124 NC/NR. 49% of the NC/NR patients undergoing liver and kidney transplantation were from Saudi Arabia and Kuwait. 7% of the kidney and 20% of the liver allografts from deceased donors were allocated to NC/NR children. There were 44 NC/NR that were removed from the list because of death or severity of illness (21 kidney and 23 liver).
A tabulation of the wait list duration, MELD score, UNOS Regions, and transplant centers that performed NC/NR transplants will be presented. The severity of illness of the wait listed candidates and the mortality rate of patients awaiting transplants in the specific UNOS region should be addressed.
Conclusions: Since the adoption of the transparency policy, < 1% of waitlist additions and < 1% of transplants have been NC/NR recipients. However, there is a disproportionate representation from 2 Middle East Countries. Review of NC/NR data is intended to promote public trust and the US to be model for the WHO principle of transparency.
[1] Organ transplantation for nonresidents of the United States: a policy for transparency. Glazier AK, Danovitch GM, Delmonico FL. Am J Transplant. 2014 Aug;14(8):1740-3.

No comments: