1
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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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2
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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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3
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Harano T, Sheth M, Sasaki K, Yu J, Wightman SC, Atay SM, Sainathan S, Kim AW. Heart transplantation for pediatric foreign nationals in the United States. Clin Transplant 2023; 37:e14900. [PMID: 36587308 DOI: 10.1111/ctr.14900] [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: 11/04/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study aimed to clarify survival outcomes, waitlist mortality, and waitlist days of heart transplantation of pediatric foreign nationals compared to pediatric United States (US) citizens. METHODS We retrieved data from March 2012 to June 2021 in the United Network Organ Sharing (UNOS) registry. RESULTS Of 5857 pediatric patients newly waitlisted, 133 (2.27%) patients were non-US citizen/non-US residents (non-citizen non-resident [NCNR]). Patients with congenital heart disease were higher in the US citizen group than in the NCNR group (51.9% vs. 22.6%, p < .001); 76.7% of patients in the NCNR group (102/133) had cardiomyopathy. Of the 133 NCNRs, 111 patients (83.5%) underwent heart transplantation, which was significantly higher than that in the US citizen group (68.6%, p < .001). The median waitlist time was 71 days (IQR, 22-172 days) in the NCNR group and 74 days (29-184 days) in the US citizen group (p = .48). Survival after heart transplant was significantly better in the NCNR group than in the US citizen group (n = 3982; logrank test p = .015). CONCLUSIONS Heart transplantation for pediatric foreign nationals was mostly indicated for cardiomyopathy, and their transplant rate was significantly higher than that in the US citizen group, with better survival outcomes. The better survival outcomes in the NCNR group compared to the US citizen group can likely be attributed to the differing diagnoses for which transplantation was performed.
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Affiliation(s)
- Takashi Harano
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Megha Sheth
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Kazunari Sasaki
- Division of Abdominal Transplant, Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Jeremy Yu
- Department of Psychiatry and Behavioral Sciences & SC CTSI Biostatistics, Epidemiology, and Research Design, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sean C Wightman
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sandeep Sainathan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami, Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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4
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Zheng K, Sutherland S, Hornby L, Shemie SD, Wilson L, Sarti AJ. Public Understandings of the Definition and Determination of Death: A Scoping Review. Transplant Direct 2022; 8:e1300. [PMID: 35415218 PMCID: PMC8989773 DOI: 10.1097/txd.0000000000001300] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 02/01/2023] Open
Abstract
Background. Advances in medicine and technology that have made it possible to support, repair, or replace failing organs challenge commonly held notions of life and death. The objective of this review is to develop a comprehensive description of the current understandings of the public regarding the meaning/definition and determination of death. Methods. This scoping review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Online databases were used to identify articles published from 2003 to 2021. Two reviewers (S.S. and K.Z.) screened the articles using predefined inclusion and exclusion criteria, extracted data for specific content variables, and performed descriptive examination. Complementary searches of reference lists complemented the final study selection. A search strategy using vocabulary of the respective databases was created, and criteria for the inclusion and exclusion of the articles were established. Results. Seven thousand four hundred twenty-eight references were identified. Sixty were retained for analysis, with 4 additional references added from complementary searches. A data extraction instrument was developed to iteratively chart the results. A qualitative approach was conducted to thematically analyze the data. Themes included public understanding/attitudes toward death and determination of death (neurological determination and cardiocirculatory determination of death), death and organ donation, public trust and legal variability, and media impacts. Conclusions. This review provides a current and comprehensive overview of the literature related to the general public’s understanding and attitudes toward death and death determination and serves to highlight the gaps in this topic.
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5
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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: 1.0] [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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6
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Ferrante ND, Goldberg DS. Transplantation in foreign nationals: Lower rates of waitlist mortality and higher rates of lost to follow-up posttransplant. Am J Transplant 2018; 18:2663-2669. [PMID: 29981179 DOI: 10.1111/ajt.15005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 01/25/2023]
Abstract
A controversial issue in the transplant community is whether or not to provide deceased donor liver transplantation (DDLT) to noncitizen/nonresidents (NCNRs) who travel for liver transplantation (LT). The expectation is that transplantation of NCNRs will not compromise access for US citizens/residents (USCRs), and that NCNRs would have similar post-LT follow-up. This has never been formally assessed. The United Network for Organ Sharing (UNOS) data from February 27, 2002 to December 31, 2016 were used to identify NCNRs and compare to USCRs, excluding Status 1 adults. Multivariable logistic regression was used to analyze waitlist outcomes, and competing risk analysis was used to assess rates of lost to follow-up post-LT. From February 27, 2002 to December 31, 2016, 1260 NCNRs were listed for LT (0.86% of listings). Adjusted probability of DDLT was not significantly different for NCNRs and USCRs (P > .5), but NCNRs were significantly less likely to be removed from the waitlist for death or clinical deterioration (aOR: 0.80, 95% CI: 0.69-0.93, P = .003). In multivariable competing risk models, NCNRs had an 11-fold higher risk of being lost to follow-up after accounting for the competing risk of death (SHR: 11.44, 95% CI: 8.72-15.01, P < .001), as well as lower rates of posttransplant mortality (SHR: 0.67, 95% CI: 0.49-0.91, P = .012). Our findings speak to the need to standardize practices for NCNRs and set expectations for post-LT care.
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Affiliation(s)
- Nicole D Ferrante
- Department of Internal Medicine, Hospital of the, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Goldberg
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, PA, USA
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7
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Budev MM. POINT: Should US Centers Transplant Solid Organs Into International Recipients? Yes. Chest 2017; 152:242-243. [DOI: 10.1016/j.chest.2017.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/27/2022] Open
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8
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Ahya VN. COUNTERPOINT: Should US Centers Transplant Solid Organs Into International Recipients? No. Chest 2017; 152:244-246. [PMID: 28215790 DOI: 10.1016/j.chest.2017.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vivek N Ahya
- Pulmonary, Allergy & Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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9
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Ahya VN. Rebuttal From Dr Ahya. Chest 2017; 152:247-248. [PMID: 28215787 DOI: 10.1016/j.chest.2017.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vivek N Ahya
- Division of Pulmonary, Allergy & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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10
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11
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Hartsock JA, Ivy SS, Helft PR. Liver Allocation to Non-U.S. Citizen Non-U.S. Residents: An Ethical Framework for a Last-in-Line Approach. Am J Transplant 2016; 16:1681-7. [PMID: 26693843 DOI: 10.1111/ajt.13674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 11/06/2015] [Accepted: 11/22/2015] [Indexed: 01/25/2023]
Abstract
The incidence of non-U.S. citizen non-U.S. resident patients coming to the United States specifically for deceased donor liver transplantation raises compelling ethical questions that require careful consideration. The inclusion of these often financially and/or socially privileged patients in the pool of potential candidates for an absolutely scarce and life-saving liver transplant may exacerbate disparities already existing in deceased donor liver allocation. In addition, their inclusion on organ transplant waiting lists conflicts with recognized ethical principles of justice and reciprocity. Moreover, preliminary data suggest that public awareness of this practice could discourage organ donation, thereby worsening an already profound supply-demand gulf. Finally, U.S. organ allocation policies and statutes are out of step with recently promulgated international transplant guidelines, which prioritize self-sufficiency of organ programs. This article analyzes each of these ethical conflicts within the context of deceased donor liver transplantation and recommends policy changes that align the United States with international practices that discourage this scenario.
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Affiliation(s)
- J A Hartsock
- Indiana University School of Liberal Arts, Indianapolis, IN.,Indiana University Health, Indianapolis, IN.,Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, IN
| | - S S Ivy
- Indiana University Health, Indianapolis, IN.,Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, IN
| | - P R Helft
- Indiana University Health, Indianapolis, IN.,Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, IN.,Indiana University-Purdue University at Indianapolis, Indianapolis, IN.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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12
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13
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Gentry SE, Chow EKH, Massie A, Luo X, Zaun D, Snyder JJ, Israni AK, Kasiske B, Segev DL. Liver sharing and organ procurement organization performance. Liver Transpl 2015; 21:293-9. [PMID: 25556648 PMCID: PMC8270535 DOI: 10.1002/lt.24074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 11/05/2014] [Accepted: 11/30/2014] [Indexed: 12/31/2022]
Abstract
Whether the liver allocation system shifts organs from better performing organ procurement organizations (OPOs) to poorer performing OPOs has been debated for many years. Models of OPO performance from the Scientific Registry of Transplant Recipients make it possible to study this question in a data-driven manner. We investigated whether each OPO's net liver import was correlated with 2 performance metrics [observed to expected (O:E) liver yield and liver donor conversion ratio] as well as 2 alternative explanations [eligible deaths and incident listings above a Model for End-Stage Liver Disease (MELD) score of 15]. We found no evidence to support the hypothesis that the allocation system transfers livers from better performing OPOs to centers with poorer performing OPOs. Also, having fewer eligible deaths was not associated with a net import. However, having more incident listings was strongly correlated with the net import, both before and after Share 35. Most importantly, the magnitude of the variation in OPO performance was much lower than the variation in demand: although the poorest performing OPOs differed from the best ones by less than 2-fold in the O:E liver yield, incident listings above a MELD score of 15 varied nearly 14-fold. Although it is imperative that all OPOs achieve the best possible results, the flow of livers is not explained by OPO performance metrics, and instead, it appears to be strongly related to differences in demand.
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Affiliation(s)
- Sommer E. Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Mathematics, US Naval Academy, Baltimore, MD
| | - Eric K. H. Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Zaun
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Jon J. Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Ajay K. Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - Bert Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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14
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Fortin MC, Williams-Jones B. Should we perform kidney transplants on foreign nationals? JOURNAL OF MEDICAL ETHICS 2014; 40:821-826. [PMID: 24277941 DOI: 10.1136/medethics-2013-101534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians' duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them.
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Affiliation(s)
- Marie-Chantal Fortin
- Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal, Montreal (CHUM), Canada Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Canada
| | - Bryn Williams-Jones
- Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Canada
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Abstract
Incentives for organ donation, currently prohibited in most countries, may increase donation and save lives. Discussion of incentives has focused on two areas: (1) whether or not there are ethical principles that justify the current prohibition and (2) whether incentives would do more good than harm. We herein address the second concern and propose for discussion standards and guidelines for an acceptable system of incentives for donation. We believe that if systems based on these guidelines were developed, harms would be no greater than those to today's conventional donors. Ultimately, until there are trials of incentives, the question of benefits and harms cannot be satisfactorily answered.
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