Basil Baccouche has a forthcoming book, which I found pretty thrilling:
The End of Death: A Surgeon, a Heart Transplant, and the Fight to Change What It Means to Die
Here's my blurb for the book:
“Basil Baccouche is a new star in the constellation of physicians who write. The End of Death tells the gripping story of a tireless doctor (Norman Shumway), a drug (cyclosporine), and a law (recognizing brain death) that combined to make heart transplants one of the miracles of modern medicine.”
Deceased organ donation in China does not yet have overwhelming public support although receiving a deceased donor organ transplant does:
Hu, D., Wang, Y., Hu, Q. et al. Public attitudes and preferences on organ donation and allocation in china: a cross-sectional study. Sci Rep 16, 24995 (2026). https://doi.org/10.1038/s41598-026-54903-4
Here's a review paper concentrating primarily on transplantation of organs (primarily kidneys) from deceased donors. It closes with a set of open research questions.
Organ Allocation and Transplantation by Itai Ashlagi and Alvin E. Roth, Annual Review of Economics, Volume 18, 2026, Vol. 18:613-645, August 2026, https://doi.org/10.1146/annurev-economics-092425-123425
ABSTRACT: There is a large shortage of solid organs for transplants. This survey reviews the allocation of organs (particularly kidneys), with an emphasis on how deceased donor organs are obtained and allocated in the United States but with pointers to related issues involving living donors and transplantation around the world. We review some of the key institutional details and theoretical and empirical studies and describe some open questions that we hope will continue to attract attention from researchers interested in the economic and operational aspects of organ allocation.
1. INTRODUCTION
"Since at least the turn of the century, organ transplants have attracted considerable interest from economists. This is due both to their importance in modern medicine and to the fact that organ transplantation deals directly with some of the most basic questions of economics—namely, how to efficiently allocate scarce resources and how to make them less scarce. "
...
OPEN QUESTIONS AND RESEARCH DIRECTIONS
This section highlights research opportunities, some of which have been raised above.
1. Can we design allocation rules free of justified envy that place hard-to-match organs quickly enough so that they remain transplantable? A large number of recovered organs that might be transplanted are discarded. How can we increase utilization of marginal-quality organs and get them accepted after fewer offers and less CIT? How can we do this in a transparent and equitable way? How can we use the information about organ quality that arrives during the offering process? 91 How can we use offer refusals in real time? How should we design allocation rules in the presence of social learning and potential information cascades (Zhang 2010, Doval et al. 2024)? How should the variability in centers’ willingness to accept marginal organs be accounted for?
2. How to design priorities to balance efficiency and equity? How can priorities be designed to account for both longevity and urgency (Zhang et al. 2024, Lazenby et al. 2025)? How can priorities depend on patients’ treatments, taking into account that treatment decisions may in turn depend on priorities (Sweat 2023)? Countries use different priority rules, and there is a need to compare these to better understand trade-offs between these rules. The OPTN is seeking to implement continuous distribution allocation policies for hearts and kidneys, which will assign priority points smoothly across patient and match features. There are not yet studies that offer guidance to the resulting (in)efficiencies. 92
3. How should organ quality be measured and reported? The KDPI is currently used for both acceptance decisions by surgeons and prioritization in the allocation system. As supply changes over time, percentiles correspond to different qualities. For example, a KDPI of 85% (which is the threshold for requiring patient consent to receive an offer) in 2018 corresponds to (i.e., has the same underlying nonnormalized KDRI risk measure as) a KDPI of 75% in 2024 due to the recovery of more organs and therefore the higher availability of organs of marginal quality. Would the use of the nonnormalized KDRI substantially change behavior and outcomes?
4. How should surgeons’ and patients’ preferences be elicited? The OPTN allows transplant centers to express preferences via filters that screen organ offers. Despite this, many organs are still declined hundreds and even thousands of times (Agarwal et al. 2021, Guan et al. 2025). How can we better design these filters? Can we use AI to help recommend filters or to predict organ refusals in real time? More broadly, how should waitlist mechanisms be designed given incomplete patient and center preferences?
5. How should transplant centers’ performance be measured? Should transplant centers be incentivized to accept marginal organs, for example, for patients facing many years of dialysis? How should we regulate transplant centers? Are new incentive schemes useful in increasing utilization? For example, how will the acceptance rate and pre-transplant mortality rate metrics impact centers’ behavior? The CMS has also launched the Increasing Organ Transplant Access model, 93 using a long-term field experiment that offers monetary incentives based on the number of transplants performed, graft survival, and percentage of accepted offers (Chan & Roth 2026.) How should we incorporate the huge role that transplant centers play in acceptance/rejection decisions when studying organ allocation mechanisms (Chan & Roth 2024, Ashlagi et al. 2025a)? There is a need for research on designing centers’ performance measures that include outcomes for patients on the waiting list.
6. How should OPO performance be measured? OPOs vary in performance in terms of organ recovery and utilization, and incentive schemes remain controversial. How effective is the new tier system for monitoring OPOs based on donation and age-adjusted transplant rates? How should OPOs be incentivized to improve performance and transparency and to coordinate with transplant centers (see Chan & Roth 2024, Bae et al. 2026, Skowronski et al. 2026)?
7. What should we incorporate in transplant centers’ preferences? Most theoretical models treat patients as the decision makers who accept or reject organ offers. In practice, however, transplant centers exercise substantial discretion over acceptance decisions, listing practices, and setting filters. How do equilibrium outcomes reflect centers’ preferences? There is a need for empirical and theoretical studies of how centers’ characteristics and incentives shape outcomes.
8. Can we design simulation tools that account for equilibrium behavior? Simulations and historical data have been instrumental to the study and design of allocation policies. Existing simulations apply myopic acceptance models that are invariant to the allocation rules. There is a need for simple modern simulation tools that account for the incentives of patients and centers. 94 It would be interesting to create tools that generate not only better equilibrium predictions but also short-term equilibration effects. 95
9. What kinds of experiments should the OPTN conduct? The OPTN conducts very few controlled experiments, despite facing ongoing allocation policy decisions. While simulation tools are useful to inform policy, field experiments offer another approach. Experiments can generate useful data to evaluate different approaches (e.g., for expediting placements). The size and heterogeneity of the United States present opportunities to test different approaches; but they also raise questions about whether different approaches would work differently in different regions, and about how to overcome the reluctance to conduct experiments.
10. How can countries with low transplant rates be helped? Many countries have low living and/or deceased donation rates. Understanding the underlying barriers (organization structure, population preferences, etc.) would be fruitful in making progress toward increasing transplant rates (see, e.g., Okubo et al. 2026).
11. What can be done to increase incentives for organ donation in ways that attract social support? What accounts for the widespread reluctance to increase organ donation by compensating donors? How can economists better explain the value of incentives in addressing scarcity and gather persuasive evidence to engage in a productive dialog with those who fear that this will increase rather than decrease black markets, or who feel there are fundamental religious or ethical objections to compensating organ donation? [For some thoughts on this, readers are referred to Roth (2026b)].
One feature of giving talks to unfamiliar audiences is that you only get noisy feedback on how your talk was received. This past June, I gave the Starzl Lecture at the American Transplant Congress in Boston. (The ATC is jointly organized by the two big American transplant societies, the AST and the ASTS,*) I spoke to an audience of about 1500 people (just a guess, but I could see some empty seats in an auditorium set up for 2,000). My talk included topics, including global kidney exchange, that have raised controversies.
Afterwards, what seemed like a lot of people came to speak to me, and were enthusiastic about my talk. But "a lot of people" was fewer than 100. So what about everyone else? (It probably wouldn't be statistically kosher to assume that those who came to congratulate me were a representative sample:)
Since global kidney exchange has led to some people calling me an organ trafficker, I didn't have any measure of the general sentiment of the meeting.
I got some reassuring news recently when the ATC sent out an email soliciting ideas for talks for next year's meeting, in Seattle. The email came with a picture from this oat meeting:
So I'm guessing this means that my talk was well received by people responsible for organizing the next meeting.
And, indeed, I'm getting multiple signals that there's an appetite for productive change in the transplant community. I hope to have more to say about that in the coming year.
######
*Acronyms:
ATC American Transplant Congress
AST American Society of Transplantation
ASTS American Society of Transplant Surgeons
After my talk yesterday at the American Transplant Congress, I had lunch with a table of transplant heroes, Joe Tector, Peter Friend, Juliana Bastos, Mike Rees and Gustavo Ferreira.
I'll be speaking Sunday at the American Transplant Congress, on kidney exchange. It will be hard to squeeze in all the recent developments in my half hour, including current controversies.
State-of-the-Art Speakers: Transplantation’s leading luminaries and innovative thinkers will share inspiring research and insights at ATC 2026.
Alvin E. Roth, PhD:
Thomas E. Starzl State-of-the-Art Lecture: The Economics of Kidney Exchange
Sunday, June 21: 11:00 AM ET
As I prepare to speak later this month at the American Transplant Congress in Boston, I note that the American Society of Transplantation (AST) has, among its Key Position Statements one from late last year called A Roadmap for Removing Disincentives for Living Organ Donors
As the title suggests, the statement focuses on removing financial disincentives for organ donation.
But I'm struck by the last item on the list:
"Additional Steps
"In advocating for the elimination of disincentives to living donation, AST will examine, in parallel, the legal,ethical, and practical considerations involved in a pilot study of financial incentives for living organ donation."
I spoke about economics with Keynes (Soumaya) in the FT:
Nobel laureate Al Roth and the economics of organ sales
"The economist Alvin Roth been talking about kidneys since at least 2003, noting time and again that kidneys are in short supply, waiting lists are growing longer, and people are dying as a result.
"So why is Roth — who appears on this week’s episode of the Economics Show podcast — still banging on about kidneys? Well, because all of those things are still getting worse."
Here is the podcast:
and here is the transcript:
" Soumaya Keynes
So we always start this show with a silly question. So, on a scale of one to 10, how relaxed are you about marketisation? So 10, you’re extremely relaxed about having transactions in literally anything, and maybe five is the average person.
Alvin Roth
So I’m probably a 7.5, maybe 7.52."
Today's debate at Hopkins aims to focus on the proposed End Kidney Deaths Act.
The Organ Donation Dilemma: Ethics, Economics, and Life-Saving Solutions
May 15, 2026 09:00 AM
"With organ shortages claiming thousands of lives annually, this session explores whether carefully designed market mechanisms can increase donation rates while maintaining ethical standards and preventing exploitation.
Panelists:
- Alexander Capron, USC Law/Bioethics https://gould.usc.edu/faculty/profile/alexander-capron/
- (TBC) Gabriel Danovitch, UCLA David Geffen School of Medicine, https://www.uclahealth.org/providers/gabriel-danovitch
- Kimberly Krawiec, UVA Law, https://www.law.virginia.edu/faculty/profile/kdk4q/1181653
- Elaine Perlman, President, Coalition to Modify NOTA and Executive Director, Waitlist Zero https://elaineperlman.com/
Moderator:
- Mario Macis, Johns Hopkins Carey Business School and HBHI https://mariomacis.net/index.html
End Kidney Deaths Act summary /sites/default/files/2026-05/The%20End%20Kidney%20Deaths%20Act%20Summary.pdf
The list of 50+ supportive organizations, the legislative text, the podcast with Kim and Elaine and the Niskanen Center's economic analysis of the End Kidney Deaths Act
This morning the Washington Post published my op-ed online (which is scheduled to appear in the print edition on Sunday). 800 words is hardly enough to explain why I think what I do...I could write a whole book about that.
But here's the op-ed:
With 90,000 patients waiting for a kidney, compensating living donors would save lives.
In Taiwan, the Ministry of Health and Welfare helps pay for the funerals of deceased organ donors.
From the Taiwan Organ Sharing Registry and Patient Autonomy Promotion Center
(2) Grants and Assistance for Donors' Families
a. Funeral Subsidies:
The MOHW provides funeral subsidies to the donor's family, including NT$50,000 for corneal donations and NT$100,000 for multiple organ donations in addition to the cornea.
b. Farewell Care Service:
In order to express our gratitude to the organ donors and their families, we provided flower baskets and certificates of appreciation at the farewell ceremony of the donors. In addition to affirming the selfless dedication of the organ donors, we also thanked the family members for their decision.
Chan A, Roth AE. Reimagining Transplant Center Incentives Beyond the CMS IOTA Model. JAMA. Published online January 26, 2026. doi:10.1001/jama.2025.26194
"On July 1, 2025, the Centers for Medicare & Medicaid Services (CMS) launched the Increasing Organ Transplant Access (IOTA) model, a national experiment in revising how transplant centers are evaluated and paid.
"For decades, transplant centers were primarily judged by 1-year graft and patient survival for patients who underwent a transplant. That standard, designed to safeguard quality, sometimes constrained access to transplants by rewarding risk avoidance rather than expansion. This contributed to persistent kidney shortages, alongside continued organ nonutilization.1
"The IOTA model marks a deliberate rebalancing. CMS is tying payment not primarily to short-term survival, but to 3 domains: achievement (60 points for transplant volume), efficiency (20 points for kidney offer acceptance), and quality (20 points for graft survival).
...
"A kidney transplant begins with an organ procurement organization (OPO). Yet OPOs remain outside the IOTA payment framework, perpetuating fragmentation between procurement and transplant.
"Recent experience with OPO performance metrics illustrates how narrow incentives can distort behavior. After CMS introduced tier-based OPO evaluations in 2021, lower-performing OPOs increased organ recovery, which also sharply increased discards, reliance on higher-risk organs, and out-of-sequence kidney placements,3 raising concerns about fairness to waitlisted patients.4
...
"Emerging economic and experimental research suggests that joint accountability—rewarding procurement and transplant entities together for improving population health—can both shift recovery, discard, and transplant numbers and produce improved gains in patient health (Table).1 Without such system-level metrics spanning OPOs and transplant centers, IOTA will operate within a fragmented ecosystem where incentives push procurement and transplant in different, sometimes counterproductive, directions."
############
See also
Bae H, Sweat KR, Melcher ML, Ashlagi I. Organ Procurement Following the Centers for Medicare and Medicaid Services Performance Evaluations. JAMA Surg. 2026;161(1):97–100. doi:10.1001/jamasurg.2025.5074
Itai Ashlagi and I weigh in on recent controversy about "out of sequence" offers of organs for transplant, with some ideas about how the current system might be redesigned and maintained so as to reduce organ discards while maintaining transparency about how and to whom organs are offered.
Itai Ashlagi and Alvin E. Roth (2026). Out of Sequence Offers: Towards Efficient, Equitable Organ Allocation. The American Journal of Bioethics, 26(1), 5–8. https://doi.org/10.1080/15265161.2026.2594937
"Organs for transplant are very scarce compared to the need, and so the allocation of organs from deceased donors raises questions about both efficiency and fairness. Because offers of organs take time to consider, and because the viability of organs from deceased donors decreases over time, efficiency sometimes requires increasing the chance of reaching a patient who will accept the organ while it remains viable. So fairness and efficiency, concerning who gets to consider the next offer, and the probability that the organ on offer will be accepted in time for it to be transplanted, may sometimes be in conflict, or at least appear to be. And even the appearance of unfairness may undercut trust in the system of organ donation and transplantation.
"This conflict between fairness and efficiency has resulted in controversy about offers made “out of sequence” (Covered in a lead article in the NYT article (Times 2025))
...
"Collecting data is essential for both efficiency and transparency. It is unfair to future patients not to have transparent allocation systems that can be studied with precision (with causal inference from experimentation), so that it can be improved over time. It is also unfair to future patients who will join increasingly congested waiting lists as a result of the failure to utilize a large number of transplantable organs.
Public data about transplant centers’ performance and patients’ waiting times would further allow patients to choose, based on their own preferences, a transplant center that fits their need.
...
"Policies to expedite the placement of marginal quality organs that can be tested over time and studied with experiments include when to determine an organ is hard-to-place and when and how to adapt the priority list.
"In summary, it is sometimes desirable to expedite an organ that risks being unused, by offering it to a patient or transplant center that is likely to accept it if the offer is received in a timely way. But it is important to make sure that this flexibility does not promote unfairness to patients or transplant centers. Increasing the transparency and efficiency of the system for expediting organs can address both these issues."
########
The same issue of the journal contains a number of articles discussing organ allocation out of sequence
########
Earlier:
The Kidney Transplant Collaborative is worried about the status of kidney transplants in the US. Here's the statement they published this month, which expresses concern about a drop in deceased donations.
"The kidney transplant waitlist has long exceeded the supply of available kidney organs. The waitlist today includes more than 94,000 Americans, with more than 28,000 deceased and living kidney transplants occurring in 2025. Even more troubling, recent events seem to have led to a decline in overall kidney transplants from 2024 to 2025, driven by a decline in deceased donor transplants. This represents the first time in the 21st century that we see an annual isolated decline in deceased donations and deceased donor kidney transplants, even while living donor kidney transplants increase and the kidney discard rate declines, the latter reflecting increased use of available deceased donor kidneys.
...
"What has caused this unprecedented and isolated decline in deceased kidney donations? While policymakers have been appropriately focused on maintaining the integrity of the
deceased donor process, an unanticipated effect of recent oversight efforts of the kidney transplant system and accompanying negative media reports has shaken the deceased donor
landscape and may have possibly caused the reduction in deceased donor rates. Given this emerging trend, the importance of increasing living donation has come into even sharper focus. Policymakers and all stakeholders in the kidney transplant process will need to focus on the impact of the recent oversight efforts and take clear measures to responsibly increase kidney transplant rates, most likely via a focus on living kidney donor supportive policy.
...
"Unreported until now, however, is the negative impact that this recent Congressional focus may be having on kidney transplant levels themselves. The impact is measurable – from 2024 to 2025, there were 116 fewer kidney transplants. This is due to 218 fewer deceased donor kidney transplants and an increase of 102 living donor kidney transplants for 2025 as compared to 2024 – the first time this century that there appears to be an isolated decline of deceased kidney donations driving the decrease in overall kidney transplants.
...
"Recent, highly publicized revelations involving OPOs have had a serious and harmful effect on public trust in organ donation. As a result, fewer individuals and families appear willing to consent to organ donation after death. Data from the OPTN Transplant Metrics National Dashboard shows that the number of kidneys recovered from deceased donors remained steady during the first half of 2025. However, beginning in June 2025, the number of deceased donors began to decline, and that decline has continued to accelerate. In 2025, a total of 15,274 deceased donors underwent kidney recovery, compared to 15,937 during 2024 for a net percentage change of negative 4.2%."
HT: Martha Gershun
The U.S. Health Resources & Services Administration (HRSA) has published a document outlining its progress in modernizing the Organ Procurement and Transplant Network (OPTN) as required by recent legislation. The idea was to make the system less dependent on the United Network for Organ Sharing (UNOS), which had been the single federal contractor running the OPTN since its inception. For the time being, at least, it appears that UNOS will continue to run the organ allocation system.
Modernizing the Nation’s Organ Donation, Procurement, and Transplantation System
"For more than 35 years, the OPTN was operated through a single national contract.
"While this structure supported growth in organ donation, procurement and transplantation, the increasing complexity of modern medicine and the demands of real-time technology, safety, data, and public accountability required a new approach.
"The bipartisan 2023 Securing the U.S. Organ Procurement and Transplant Network Act gave a clear mandate: bring the OPTN into the modern era of governance, technology, and healthcare delivery".
Most organ transplants come from deceased donors, and the vast majority of these deceased donor organs are allocated by a regulated system of national waiting lists. That is, the organs of a deceased donor go to strangers in need. In contrast, most transplants from living donors (of kidneys and livers) are direct donations from someone healthy enough to donate to someone who they know.* Living donations are also different in that they can be planned well in advance, while deceased donations have to be hastily arranged following a death.
But it is legal, and sometimes possible, for the next of kin of a deceased potential donor to direct an organ donation to someone they know who needs a transplant. This will only take place if the potential recipient is available on short notice, and if the donor organ is compatible with the recipient. So it's a rare event: the next of kin need to know someone in need, and the transplant has to turn out to be feasible.
But rare events happen, and the NYT reports on just such a story:
A Man Who Shunned Cheap Sentiment Left a Gift for Others: Life By Dan Barry
"Informed that her 55-year-old brother would never regain consciousness, Darlene Costello made the heartbreaking decision to have him removed from his ventilator — only to learn, seconds before it was time, that Brendan was a registered organ donor.
"Once Ms. Costello calmed down — why wasn’t this known before? — she came to embrace the news of her brother’s final selfless act. She also knew someone who desperately needed a kidney. Calls were made, tests done, overwhelming odds overcome."
...
" His lungs went to a woman in Tennessee, his right kidney to a man in Pennsylvania. And his left kidney was received by Ms. Costello’s mentor and employer, Dr. Sylvio Burcescu, 62, whose ability to run his Westchester County clinic had been hampered by a rare kidney disease requiring dialysis."
########
*Nondirected living donors can also start chains of kidney exchange.
Last month I was interviewed in connection with the new edition of the Chinese translation of my 2015 book Who Gets What and Why.
Here is the interview in Chinese, and translated back to English. (You can also click "translate to English" from the Chinese version, to get a more creative translation that among other things renders my name as variations on "Erwin Ross.")
Below are some excerpts from the better back-translation (from interview in English translated into Chinese, and then back to English):
"In November 2025, LatePost conducted a video interview with Roth. The interview began at 7 a.m. local time, and the 74-year-old had already arrived at his office, walking on a treadmill desk while conversing with us. A white beard, furrowed brow when deep in thought, a smiling expression, and concise communication—these are the impressions Roth gave during the conversation.
'Market design is economics confronting the external world,' Roth told us. A month earlier, his popular book on market design, Who Gets What―and Why, was republished in Chinese under the title Matching. Designing, improving, and maintaining well-functioning matching mechanisms is the work of market design. In Matching, Roth demonstrated how market design could be applied in practice to change people's destinies and the way societies operate.
...
"Alvin Roth: Significant changes have occurred in both kidney transplantation and kidney exchange. By the way, since 2015, there has been a major transformation in the approach to transplant surgeries in China. Prior to that, most organs used in transplants came from executed prisoners; now, China is developing a voluntary organ donation program, which represents a significant shift. However, China has yet to initiate kidney exchange programs.
"A new global trend is that we are beginning to experiment with cross-border kidney exchanges. This is particularly crucial for smaller countries or regions with limited numbers of kidney transplants, where some patients struggle to find compatible donors.
...
"Q: In your "Market Design" blog, you previewed a new book to be published next year titled Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work. Why did you write this book? What issues do you discuss and how do you address them?
"Alvin Roth: One issue that economists have yet to fully understand is which markets gain societal support and which ones do not. For instance, I have explored the surrogacy market. Surrogacy is legal in the United States but illegal in China. After the Chinese government relaxed its one-child policy, many people desired to have a second child, but age became an obstacle. In California, where I reside, there are agencies offering surrogacy services where Mandarin is spoken, and many clients come from China.
"This is one of the core questions I attempt to address: why are certain genuinely beneficial practices legal in some places but illegal in others? "
#######
When I search for the new edition on Google I get the following AI overview:
The U.S. transplant system is relatively open to foreign patients, and the NYT reports with some concern the number of foreign citizens receiving scarce organs from deceased donors, sometimes paying full list price to the hospitals involved. One question I have that I haven't seen addressed in discussions of this type is how many foreign citizens who happen to die while visiting the US become deceased organ donors?
Here's the NYT:
Hospitals Cater to ‘Transplant Tourists’ as U.S. Patients Wait for Organs
International patients can bring a hospital as much as $2 million for a transplant. In recent years, they have typically gotten organs faster than U.S. patients. By Brian M. Rosenthal and Mark Hansen
"In the past dozen years, more than 1,400 patients from abroad received a transplant in the United States after traveling specifically for the procedure. That was a small fraction of all U.S. transplants, and most transplant centers did not operate on international patients at all.
"But The Times found that a handful of hospitals are increasingly catering to overseas patients, who make up an ever-larger share of their organ recipients: 11 percent for hearts and lungs at the University of Chicago; 20 percent for lungs at Montefiore Medical Center in the Bronx; 16 percent for lungs at UC San Diego Health; 10 percent for intestines at MedStar Georgetown University Hospital in Washington; and 8 percent for livers at Memorial Hermann-Texas Medical Center in Houston.
"In many countries, this would be illegal. World leaders agreed in 2008 to fight so-called transplant tourism, and most nations do not provide organs to overseas patients. Yet the United States has long allowed it. The policy has drawn criticism in the past, such as when organs went to Saudi royals and a Japanese crime boss.
...
"Dr. Mark Fox, a former chair of the transplant system’s ethics committee, said the findings were troubling, especially because overseas patients do not contribute to America’s pool of donated organs. “The unfortunate reality is that we don’t have enough organs,” he said. “When people jet in, get an organ and jet home, it’s a problem. It’s not fair.”
##########
I'm reminded of this 2018 article which expressed a similar concern :
Delmonico, F. L., Gunderson, S., Iyer, K. R., Danovitch, G. M., Pruett, T. L., Reyes, J. D., & Ascher, N. L. (2018). Deceased donor organ transplantation performed in the United States for noncitizens and nonresidents. Transplantation, 102(7), 1124-1131.
Abstract: "Since 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the citizenship residency status of patients undergoing transplantation in the United States. This policy replaced the 5% threshold of the non–US citizen/nonresidents (NC/NR) undergoing organ transplantation that could result in an audit of transplant center activity. Since April 1, 2015, the country of residence for the NC/NR on the waitlist has also been recorded. We analyzed the frequency of NC/NR deceased donor organ transplants and waitlist registrations at all US transplant centers by data provided by UNOS for that purpose to the UNOS Ad Hoc International Relations Committee. During the period of 2013 to 2016, 1176 deceased donor transplants (of all organs) were performed in non–US citizen/non–US resident (NC/NR) candidates (0.54% of the total number of transplants). We focused on high-volume NC/NR transplant centers that performed more than 5% of the deceased donor kidney or liver transplants in NC/NR or whose waitlist registrants exceeded 5% NC/NR. This report was prepared to fulfill the transparency policy of UNOS to assure a public trust in the distribution of organs. When viewed with a public awareness of deceased donor organ shortages, it suggests the need for a more comprehensive understanding of current NC/NR activity in the United States. Patterns of organ specific NC/NR registrations and transplantations at high-volume centers should prompt a review of transplant center practices to determine whether the deceased donor and center resources may be compromised for their US patients."
They note that " a noncitizen/nonresident could be a foreign student or businessperson traveling to the United States, whereas an undocumented individual living in the United States would also be a noncitizen/resident."
"All politics is local" may not be entirely true, but local politics doesn't end at death.
MedPage Today has the story:
Senators Urge More Localized Use of Donor Organs
— "Too many of our organs are leaving" the geographic area, says Sen. Roger Marshall, MD
by Joyce Frieden,
"More needs to be done to make sure donated organs are transplanted to recipients within the local geographic area whenever possible, several senators said Thursday at a hearing on the future of the organ procurement and transplantation network.
"The Midwest, where I'm from ... is famous that we have a higher organ donor rate than the [East or West] coasts do typically," said Sen. Roger Marshall, MD (R-Kansas). "And you know, there's a concern that too many of our organs are leaving the Midwest."
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