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1
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Menon G, Metoyer GT, Li Y, Chen Y, Bae S, DeMarco MP, Lee BP, Loarte-Campos PC, Orandi BJ, Segev DL, McAdams-DeMarco MA. A national registry study evaluated the landscape of kidney transplantation among presumed unauthorized immigrants in the United States. Kidney Int 2025:S0085-2538(25)00088-2. [PMID: 39956339 DOI: 10.1016/j.kint.2025.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 01/17/2025] [Accepted: 01/29/2025] [Indexed: 02/18/2025]
Abstract
Unauthorized immigrants and permanent residents may experience challenges in accessing kidney transplantation due to limited healthcare access, socioeconomic and cultural barriers. Understanding the United States (US) national landscape of kidney transplantation for non-citizens may inform policy changes. To evaluate this, we utilized two cohorts from the US national registry (2013-2023): 287,481 adult candidates for first transplant listing and 190,176 adult first transplant recipients. Citizenship was categorized as US citizen (reference), permanent resident, and presumed unauthorized immigrant. Negative binomial regression was used to quantify the incidence rate ratio over time by citizenship status. Cause-specific hazards models, with clustering at the state of listing/transplant, were used to calculate the adjusted hazard ratio of waitlist mortality, kidney transplant, and post-transplant outcomes (mortality/death-censored graft failure) by citizenship category. The crude proportion of presumed unauthorized immigrants listed increased over time (2013: 0.9%, 2023:1.9%). However, after accounting for case mix and waitlist size, there was no change in listing over time. Presumed unauthorized immigrants were less likely to experience waitlist mortality (adjusted Hazard Ratio 0.54, 95% Confidence Interval: 0.46-0.62), were more likely to obtain deceased donor kidney transplant (1.11: 1.05-1.18), but less likely to receive live donor (0.80: 0.71-0.90) or preemptive kidney transplant (0.52: 0.43-0.62). When stratified by insurance status, presumed unauthorized immigrants on Medicaid were less likely to receive deceased donor kidney transplants compared to their citizen counterparts; however, presumed unauthorized immigrants with private insurance or Medicare were more likely to receive deceased donor kidney transplants. Presumed unauthorized immigrants were less likely to experience post-transplant death (0.56: 0.43-0.69) and graft failure (0.69: 0.57-0.84). Residents had similar pre- and post-transplant outcomes. Despite the barriers to kidney transplantation faced by presumed unauthorized immigrants and residents in the US, better post-transplant outcomes for presumed unauthorized immigrants compared to citizens persisted, even after accounting for differences in patient characteristics.
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Affiliation(s)
- Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Garyn T Metoyer
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Yusi Chen
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Sunjae Bae
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Mario P DeMarco
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian P Lee
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Pablo C Loarte-Campos
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Babak J Orandi
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
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2
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Nunez M, Abbasi A, McEnhill M, Brennan J, Shappell T, Kinnier S, Winnicki E, Stock P. Long-term impact of immigration status on outcomes in pediatric kidney transplant recipients. Am J Transplant 2025; 25:368-375. [PMID: 39278627 DOI: 10.1016/j.ajt.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 08/16/2024] [Accepted: 09/09/2024] [Indexed: 09/18/2024]
Abstract
This study aimed to investigate the effects of documentation status on pediatric kidney transplant outcomes in a single-center setting, emphasizing the significance of state insurance access for undocumented patients and federal policies like Deferred Action for Childhood Arrivals (DACA) on patient outcomes. A cohort of 283 patients, including 48 undocumented individuals, who received their first kidney transplant as children between 1998 and 2011 was analyzed. There was no significant difference in unadjusted all-cause (P = .91) and death-censored (P = .38) graft survival between undocumented patients and patients with permanent legal status, subsequently referred to as US residents. Additionally, in the Cox proportional hazards model, immigration status was not significantly associated with all-cause graft survival (hazard ratio 0.87, 95% CI 0.51-1.46, P = .6). Telephone interviews were conducted with the undocumented cohort. Forty-one of 48 of the undocumented recipients were contacted. Ninety-five percent had access to insurance with 68.3% on Medicaid or Medicare. DACA recipients exhibited higher employment rates (88% vs 67%, P = .11) and were more likely to complete a degree beyond high school (47.1% vs 12.5%, P = .01). Immigration status did not impact long-term graft survival, suggesting eligibility expansions for state-funded insurance and DACA may improve access to transplant care for undocumented patients. Moreover, DACA recipients showed trends toward increased employment and education compared to non-DACA recipients.
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Affiliation(s)
- Miguel Nunez
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ali Abbasi
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Marilyn McEnhill
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jessica Brennan
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Taryn Shappell
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Sarah Kinnier
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Erica Winnicki
- Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Peter Stock
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA.
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Nguyen AB, Roth HF, Chung B, Rodgers D, Clerkin KJ, Sayer G, Kim G, Jeevanandam V, Siegler M, Uriel N, Aronsohn A. International Travel for Organ Transplantation: Provider and Patient Perspectives. Transplant Direct 2024; 10:e1686. [PMID: 39035117 PMCID: PMC11259398 DOI: 10.1097/txd.0000000000001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 07/23/2024] Open
Abstract
Background Organ allocation in the United States to non-US citizen, non-US residents who travel for transplant (NC/NRTx) is controversial. Current policies may not be informed by stakeholder opinions, as limited data exist assessing the knowledge or opinions of providers or patients on this issue. Methods A cross-sectional, hospital-based pilot survey was distributed to providers and patients from December 2019 to June 2020 at a single large urban transplant institute. Providers were members of the departments of surgery and medicine and included both transplant and nontransplant providers. Surveys included 10 questions on eligibility, prioritization, and limitations for deceased donor transplantation and 12 demographic questions. Results A total of 209 providers responded (61% women, median age 40) and 119 patients responded (62% women, median age 54). Awareness of eligibility for transplantation of US citizens, non-US citizens residing in the United States (NC/R), and NC/NRTx was high in both groups, though providers and patients lacked awareness of the eligibility of nonlegal NC/R (those who live in the United States who are not citizens and are not legal residents) to donate and receive organs. Overall, 79.3% of patients stated that NC/NRTx should be eligible for transplant in the United States compared with only 60.7% of providers (P = 0.001). Providers were more likely than patients to prioritize transplant to legal NC/NR over NC/NRTx (58.2% versus 35.1%, P < 000.1) and reported that families should be able to limit donations to NC/NRTx (34.9% versus 23.2%, P = 0.03). Conclusions Surveyed patients and providers generally support transplant in non-US citizens; however, the strength of support varied considerably based on the legal status of the patient and the occupation of those surveyed. Larger studies are necessary to develop data-informed policy.
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Affiliation(s)
- Ann B. Nguyen
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, IL
| | - Hannah F. Roth
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL
| | - Bow Chung
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, IL
| | - Daniel Rodgers
- Department of Surgery, Section of Cardiac Surgery, University of Chicago Medicine, Chicago, IL
| | - Kevin J. Clerkin
- Department of Medicine, Section of Cardiology, Columbia University Medical Center, New York, NY
| | - Gabriel Sayer
- Department of Medicine, Section of Cardiology, Columbia University Medical Center, New York, NY
| | - Gene Kim
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, IL
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac Surgery, University of Chicago Medicine, Chicago, IL
| | - Mark Siegler
- Department of Medicine, Section of General Medicine, Bucksbaum Institute for Clinical Excellence, University of Chicago Medicine, Chicago, IL
| | - Nir Uriel
- Department of Medicine, Section of Cardiology, Columbia University Medical Center, New York, NY
| | - Andrew Aronsohn
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL
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Stock PG, Nagral S, Rondeau E, Gawronska S, Groverman J, Barbari A, Coates PT, Domínguez-Gil B, Fadhil R, Malyszko J, Niño Murcia A. Transplantation in the Context of Migration and Refugees: A Summary of the DICG and TTS Ethics Committee Workshop, Buenos Aires, Argentina, September 2022. Transplantation 2024; 108:1476-1487. [PMID: 38383953 DOI: 10.1097/tp.0000000000004918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Global conflicts and humanitarian crises have resulted in an unprecedented number of refugees and migrants. This challenges the limited resources of health care systems and jeopardizes the availability of transplant care for these deserving migrants and refugees. This was the basis for a workshop held during the Congress of the Transplantation Society (Buenos Aires, 2022). We elaborate on the proceedings of the workshop entitled "Transplantation in the Context of Migration and Refugees," organized by the Ethics Committee of The Transplantation Society and Declaration of Istanbul Custodian Group. Transplant providers from around the world shared strategies of how each region has responded to providing access to care for refugees and migrants in need of transplant services. The potential exploitation of this vulnerable group leading to illicit organ removal was addressed for each region. The Transplantation Society, Declaration of Istanbul Custodian Group, and global transplant community should continue to focus on the status of refugees and migrants and collaborate on strategies to provide access to transplant care for this deserving population. Global cooperation will be essential to provide vigilant oversight to prevent exploitation of this vulnerable population.
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Affiliation(s)
- Peter G Stock
- Department of Transplant Surgery, University of California San Francisco, San Francisco, CA
- Ethics Committee of The Transplantation Society, Montreal, QC, Canada
| | - Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
- Declaration of Istanbul Custodian Group (DICG), Montreal, QC, Canada
| | - Eric Rondeau
- Declaration of Istanbul Custodian Group (DICG), Montreal, QC, Canada
- Soins intensifs nephrologiques et Rein aigu, hôpital Tenon, Paris, France
| | - Sylwia Gawronska
- United Nations Office on Drugs and Crime (UNODC), Regional Office for Southeast Asia and the Pacific (ROSEAP), Bangkok, Thailand
| | | | - Antoine Barbari
- Department of Nephrology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - P Toby Coates
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Beatriz Domínguez-Gil
- Ethics Committee of The Transplantation Society, Montreal, QC, Canada
- Organización Nacional de Trasplantes, Madrid, Spain
| | - Riadh Fadhil
- Ethics Committee of The Transplantation Society, Montreal, QC, Canada
- Qatar Organ Donation Centre, Hamad Medical Corporation, Doha, Qatar
| | - Jolanta Malyszko
- Declaration of Istanbul Custodian Group (DICG), Montreal, QC, Canada
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Alejandro Niño Murcia
- Ethics Committee of The Transplantation Society, Montreal, QC, Canada
- Department of Transplantation Surgery, Colombiana de Trasplantes, Bogotá, Colombia
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5
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Roth HF, Aronsohn AI. Ethics and downstream effects of travel for transplant in the United States. Clin Liver Dis (Hoboken) 2024; 23:e0242. [PMID: 38912002 PMCID: PMC11191884 DOI: 10.1097/cld.0000000000000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/19/2024] [Indexed: 06/25/2024] Open
Affiliation(s)
- Hannah F. Roth
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
| | - Andrew I. Aronsohn
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
- MacLean Center for Clinical Medical Ethics, University of Chicago Medicine, Chicago, Illinois, USA
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Thongprayoon C, Vaitla P, Jadlowiec CC, Leeaphorn N, Mao SA, Mao MA, Qureshi F, Kaewput W, Qureshi F, Tangpanithandee S, Krisanapan P, Pattharanitima P, Acharya PC, Nissaisorakarn P, Cooper M, Cheungpasitporn W. Distinct Phenotypes of Non-Citizen Kidney Transplant Recipients in the United States by Machine Learning Consensus Clustering. MEDICINES (BASEL, SWITZERLAND) 2023; 10:medicines10040025. [PMID: 37103780 PMCID: PMC10144541 DOI: 10.3390/medicines10040025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/24/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Better understanding of the different phenotypes/subgroups of non-U.S. citizen kidney transplant recipients may help the transplant community to identify strategies that improve outcomes among non-U.S. citizen kidney transplant recipients. This study aimed to cluster non-U.S. citizen kidney transplant recipients using an unsupervised machine learning approach; Methods: We conducted a consensus cluster analysis based on recipient-, donor-, and transplant- related characteristics in non-U.S. citizen kidney transplant recipients in the United States from 2010 to 2019 in the OPTN/UNOS database using recipient, donor, and transplant-related characteristics. Each cluster's key characteristics were identified using the standardized mean difference. Post-transplant outcomes were compared among the clusters; Results: Consensus cluster analysis was performed in 11,300 non-U.S. citizen kidney transplant recipients and identified two distinct clusters best representing clinical characteristics. Cluster 1 patients were notable for young age, preemptive kidney transplant or dialysis duration of less than 1 year, working income, private insurance, non-hypertensive donors, and Hispanic living donors with a low number of HLA mismatch. In contrast, cluster 2 patients were characterized by non-ECD deceased donors with KDPI <85%. Consequently, cluster 1 patients had reduced cold ischemia time, lower proportion of machine-perfused kidneys, and lower incidence of delayed graft function after kidney transplant. Cluster 2 had higher 5-year death-censored graft failure (5.2% vs. 9.8%; p < 0.001), patient death (3.4% vs. 11.4%; p < 0.001), but similar one-year acute rejection (4.7% vs. 4.9%; p = 0.63), compared to cluster 1; Conclusions: Machine learning clustering approach successfully identified two clusters among non-U.S. citizen kidney transplant recipients with distinct phenotypes that were associated with different outcomes, including allograft loss and patient survival. These findings underscore the need for individualized care for non-U.S. citizen kidney transplant recipients.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pradeep Vaitla
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | | | - Napat Leeaphorn
- Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke's Health System, Kansas City, MO 64108, USA
| | - Shennen A Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Fahad Qureshi
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Pattharawin Pattharanitima
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Thammasat University, Pathum Thani 12120, Thailand
| | - Prakrati C Acharya
- Division of Nephrology, Texas Tech Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Pitchaphon Nissaisorakarn
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC 21042, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Cervantes L, Rizzolo K, Klassen D. Organ Procurement and Transplant Equity Among US Residents: The 5% Guideline. Am J Kidney Dis 2021; 80:139-142. [PMID: 34974030 DOI: 10.1053/j.ajkd.2021.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/21/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Lilia Cervantes
- Division of Hospital Medicine, Denver Health; Office of Research, Denver Health; Division of General Internal Medicine, University of Colorado Anschutz Medical Campus.
| | - Katherine Rizzolo
- Department of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus
| | - David Klassen
- Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, Virginia
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8
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Braun HJ, Ascher NL. Travel for Transplantation: A Review of Domestic and International Travel for Liver Transplantation in the United States. Clin Liver Dis (Hoboken) 2021; 18:292-296. [PMID: 34976374 PMCID: PMC8688895 DOI: 10.1002/cld.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/11/2021] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Hillary J. Braun
- Division of TransplantDepartment of SurgeryUniversity of CaliforniaSan FranciscoCA
| | - Nancy L. Ascher
- Division of TransplantDepartment of SurgeryUniversity of CaliforniaSan FranciscoCA
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Pérez-Blanco A, López-Fraga M, Forsythe J, Pires Silva AM, Cardillo M, Novotná P, Tullius SG, Cozzi E, Ashkenazi T, Delmonico FL, Domínguez-Gil B, Brix-Zuleger M, Colenbie L, Tsoneva D, Bušić M, Nicolaos M, Adamec M, Makisalo H, Arrabal S, Pérel Y, Cantrelle C, Legeai C, Rahmel A, Menoudakou G, Sándor M, Lavee J, Bellis L, Ciaccio P, Gembutiene V, Abela C, Codrenau I, Kaminski A, Kratka M, Avsec D, Alvarez M, Carmona M, Beyeler F, Thaqi A, Haase B, Ünsal İ, Gardiner D, McGowan O, Branger P, Ericzon BG, Birrell L. Access of non-residents to transplantation of deceased donor organs: practices and strategies in the European setting. Transpl Int 2021; 34:2112-2121. [PMID: 34553794 DOI: 10.1111/tri.14113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
The access of non-resident patients to the deceased donor waiting list (DDWL) poses different challenges. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) has studied this phenomenon in the European setting. A questionnaire was circulated among the Council of Europe member states to inquire about the criteria applied for non-residents to access their DDWL. Information was compiled from 28 countries. Less than 1% of recipients of deceased donor organs were non-residents. Two countries never allow non-residents to access the DDWL, four allow access without restrictions and 22 only under specific conditions. Of those, most give access to non-resident patients already in their jurisdictions who are in a situation of vulnerability (urgent life-threatening conditions). In addition, patients may be given access: (i) after assessment by a specific committee (four countries); (ii) within the framework of official cooperation agreements (15 countries); and (iii) after patients have officially lived in the country for a minimum length of time (eight countries). The ethical and legal implications of these policies are discussed. Countries should collect accurate information about residency status of waitlisted patients. Transparent criteria for the access of non-residents to DDWL should be clearly defined at national level.
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Affiliation(s)
| | - Marta López-Fraga
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | | | - Ana M Pires Silva
- Instituto Português de Sangue e da Transplantação (IPST), Lisbon, Portugal
| | - Massimo Cardillo
- Centro Nazionale Trapianti-Istituto Superiore di Sanità (CNT-ISS), Rome, Italy
| | - Petra Novotná
- Koordinační středisko transplantací (KST), Prague, Czech Republic
| | - Stefan G Tullius
- Division of Transplant Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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10
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Neupane R, Taweesedt PT, Anjum H, Surani S. Current state of medical tourism involving liver transplantation-the risk of infections and potential complications. World J Hepatol 2021; 13:717-722. [PMID: 34367493 PMCID: PMC8326159 DOI: 10.4254/wjh.v13.i7.717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/29/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
Liver transplant has been shown to significantly improve mortality and quality of life in various liver diseases such as acute liver failure, end-stage liver disease, and liver cancer. While the organ transplant demand is continuing to rise, the organ donation supply remains unmatched. The organ shortage, high cost, and long waiting lists have stimulated a desire for routes that may be unethical. This process which is named transplant tourism is the term used to describe traveling to another country to purchase an organ for transplant. Liver transplant tourism has been associated with post-transplant complications and higher mortality compared to a domestic liver transplant. Improper pre-and post-transplant infectious screening, inadequate opportunistic infection prophylaxis, and loss to follow-up were noted in patients who travel abroad for a liver transplant. It is crucial to understand the risk of transplant tourism to prevent morbidity and mortality.
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Affiliation(s)
- Ritesh Neupane
- Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA 17033, United States
| | - Pahnwat Tonya Taweesedt
- Department of Medicine, Corpus Christi Medical Center, Corpus Christi, TX 78412, United States
| | - Humayun Anjum
- Department of Medicine, University of North Texas, Corpus Christi, TX 78412, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University, College Station, TX 77843, United States
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11
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Alhaider S, Maddox J, Heinle J, Shebaro I, Mallory G. A systematic approach to transplanting non-resident, non-citizens in an established US pediatric lung transplant program. Int J Pediatr Adolesc Med 2021; 9:16-21. [PMID: 35573062 PMCID: PMC9072238 DOI: 10.1016/j.ijpam.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
Introduction Methods Results Conclusion
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12
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Lee BP, Terrault NA. Liver Transplantation in Unauthorized Immigrants in the United States. Hepatology 2020; 71:1802-1812. [PMID: 31487391 PMCID: PMC7103423 DOI: 10.1002/hep.30926] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/05/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Eleven million unauthorized immigrants reside in the United States and may account for 3% of deceased organ donors. Recently introduced federal and state legislation propose to address access to organ transplantation among unauthorized immigrants. The national landscape of liver transplantation (LT) for unauthorized immigrants is unknown. APPROACH AND RESULTS We included all US LT recipients between March 2012 and December 2018 who were linked to Pew Center of Research data to estimate the population of unauthorized immigrants in each US state and by country of origin, based on US Census data. We categorized patients as unauthorized immigrants versus US citizens/residents. The main outcome measures were (1) the proportion of LTs performed for unauthorized immigrants compared with the proportion of unauthorized immigrants among total population in each US state and (2) graft failure and death post-LT. Of 43,192 LT recipients, 43,026 (99.6%) were US citizens/residents and 166 (0.4%) were unauthorized immigrants. Among unauthorized immigrants, most LTs were performed in California (47%) and New York (18%). The absolute difference in proportion of LTs performed for unauthorized immigrants compared with the proportion of unauthorized immigrants among the total population differed among states, ranging from +20% in California to -12% in Texas. The most common countries of birth among LT recipients who were unauthorized immigrants were Mexico (52%), Guatemala (7%), China (6%), El Salvador (5%), and India (5%). In competing risk analysis, unauthorized immigration status (vs. US citizens/residents) was associated with a similar risk of graft failure (subdistribution hazard ratio [sHR] 0.74; 95% confidence interval [CI], 0.40-1.34; P = 0.38) and death (sHR 0.68; 95% CI, 0.36-1.29; P = 0.23). CONCLUSIONS LT for unauthorized immigrants is rare, and disparities in access to LT by state are present. Patient and graft survival among unauthorized immigrants is comparable with citizens/residents.
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Affiliation(s)
- Brian P. Lee
- Department of Gastroenterology, University of California, San Francisco, San Francisco, CA
| | - Norah A. Terrault
- Department of Gastroenterology, University of Southern California, Los Angeles, CA
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13
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Hindi Z, Congly S, Tang E, Skaro A, Brahmania M. Liver Transplant Tourism. Liver Transpl 2020; 26:276-282. [PMID: 31765044 DOI: 10.1002/lt.25692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
Liver transplant tourism is travel for transplantation involving organ trafficking and/or transplant commercialism. Various medical, financial, and organizational factors play a role in transplant care including waiting lists, Model for End-Stage Liver Disease scores, and financial aid. We outline the international experiences with transplant tourism (TT) and its effect on their medical communities and patients. For clinicians providing care to patients involved in TT, we also discuss pretransplant counseling and posttransplant care.
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Affiliation(s)
- Zaid Hindi
- Department of Medicine, Division of Gastroenterology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Stephen Congly
- Department of Medicine, Division of Gastroenterology, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Ephraim Tang
- Department of Surgery, Division of General Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Anton Skaro
- Department of Surgery, Division of General Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mayur Brahmania
- Department of Medicine, Division of Gastroenterology, London Health Sciences Centre, Western University, London, Ontario, Canada
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14
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Greenberg R, Ballesteros-Gallego F, Allard J, Fortin MC. Organ Transplantation for Foreign Nationals in Canada: A Survey of Transplant Professionals. Can J Kidney Health Dis 2019; 6:2054358119859530. [PMID: 31308952 PMCID: PMC6607567 DOI: 10.1177/2054358119859530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Transplantation for foreign nationals (non-citizens and non-residents) (FNs) in Canada is a complex issue. Currently, there are no Canadian guidelines for the provision of organ transplantation for FNs, and no empirical data on this issue or on transplant professionals’ practices are available. Objective: This project aimed to gather empirical data on transplant professionals’ perspectives and practices regarding transplantation for FNs. Design: Survey research design. Setting: A Web-based survey of members of the Canadian Society of Transplantation (CST). Participants: All members of the CST were invited to participate between April and June 2016. Measurements: Multiple-choice questions were developed to capture participants’ attitudes toward different fictitious clinical scenarios in which an FN needed a transplant, their experiences with FNs, their attitude toward FNs in need of transplantation, their knowledge about relevant institutional and organ donation organization (ODO) policies, and their perspectives on a quota. There were two questions with a five-point Likert scale to measure respondents’ agreement with statements related to possible policy options and arguments for and against transplantation for FNs. There was one open-ended question about the content of transplant programs’ policies on transplantation for FNs. Methods: Descriptive statistical analysis were performed. Results: A total of 87 transplant professionals completed the survey. Over the 4-year period from 2012 to 2016, 47.1% of respondents dealt with at least one situation of listing or performing a transplant for an FN. Only 19.5% of respondents reported that their transplant program had a policy about transplantation for FNs and 59.7% did not know if their ODO had such a policy. When asked about policy options, 47.5% disagreed with a policy of no transplantation for FNs and 41.4% agreed with offering transplantation for FNs in some circumstances (including life-saving and non–life-saving organs). Study participants agreed that transplantation should not be offered to FNs traveling to Canada specifically for transplantation, that FNs should not be transplanted with organs not suitable for Canadian citizens and that there should not be a transplantation quota for FNs. Participants also seem to be more inclined to offer transplantation of life-saving organs, particularly for children. Limitations: The major limitation of this study is the low response rate of transplant professionals to this survey. Conclusion: This is the first study to describe Canadian transplant professionals’ perspectives on transplantation for FNs. The findings of this study will be of interest for future policy development on access to transplantation for FNs. Further studies are needed to gather various key stakeholders’ perspectives on this issue, as well as to analyze the legal and ethical issues and the economics, to develop future policies.
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Affiliation(s)
- Rebecca Greenberg
- Department of Bioethics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada
| | - Fabián Ballesteros-Gallego
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Julie Allard
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marie-Chantal Fortin
- The Canadian Donation and Transplant Research Program, Edmonton, AB, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Université de Montréal, QC, Canada
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15
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Al Ammary F, Thomas AG, Massie AB, Muzaale AD, Shaffer AA, Koons B, Qadi MA, Crews DC, Garonzik-Wang J, Fang H, Brennan DC, Lentine KL, Segev DL, Henderson ML. The landscape of international living kidney donation in the United States. Am J Transplant 2019; 19:2009-2019. [PMID: 30615253 PMCID: PMC6591087 DOI: 10.1111/ajt.15256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/31/2018] [Accepted: 01/01/2019] [Indexed: 01/25/2023]
Abstract
In the United States, kidney donation from international (noncitizen/nonresident) living kidney donors (LKDs) is permitted; however, given the heterogeneity of healthcare systems, concerns remain regarding the international LKD practice and recipient outcomes. We studied a US cohort of 102 315 LKD transplants from 2000-2016, including 2088 international LKDs, as reported to the Organ Procurement and Transplantation Network. International LKDs were more tightly clustered among a small number of centers than domestic LKDs (Gini coefficient 0.76 vs 0.58, P < .001). Compared with domestic LKDs, international LKDs were more often young, male, Hispanic or Asian, and biologically related to their recipient (P < .001). Policy-compliant donor follow-up was substantially lower for international LKDs at 6, 12, and 24 months postnephrectomy (2015 cohort: 45%, 33%, 36% vs 76%, 71%, 70% for domestic LKDs, P < .001). Among international LKDs, Hispanic (aOR = 0.23 0.360.56 , P < .001) and biologically related (aOR = 0.39 0.590.89 , P < .01) donors were more compliant in donor follow-up than white and unrelated donors. Recipients of international living donor kidney transplant (LDKT) had similar graft failure (aHR = 0.78 0.891.02 , P = .1) but lower mortality (aHR = 0.53 0.620.72 , P < .001) compared with the recipients of domestic LDKT after adjusting for recipient, transplant, and donor factors. International LKDs may provide an alternative opportunity for living donation. However, efforts to improve international LKD follow-up and engagement are warranted.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashton A Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Brittany Koons
- Department of Nursing, Villanova University, Villanova, Pennsylvania
| | - Mohamud A Qadi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Hai Fang
- Department of Health Systems, Management and Policy, University of Colorado School of Public Health, Aurora, Colorado
| | - Daniel C Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Krista L Lentine
- Department of Medicine, Saint Louis University, St. Louis, Missouri
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
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16
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Iyer KR, Gunderson S, Friedman B. Transplantation in foreign nationals: Need for greater transparency. Am J Transplant 2019; 19:1868-1869. [PMID: 30725524 DOI: 10.1111/ajt.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Kishore R Iyer
- OPTN Ad Hoc International Relations Committee, Mount Sinai Medical Center, New York, New York
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17
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Rahmel A, Feng S. Liver transplants for noncitizens/nonresidents: What is the problem, and what should be done? Am J Transplant 2018; 18:2620-2621. [PMID: 30080314 DOI: 10.1111/ajt.15059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/29/2018] [Accepted: 07/29/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Axel Rahmel
- Deutsche Stiftung Organtransplantation, Frankfurt am Main, Germany
| | - Sandy Feng
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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