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. 2022 Feb 1;106(2):e141-e152.
doi: 10.1097/TP.0000000000003970.

International Travel for Liver Transplantation: A Comprehensive Assessment of the Impact on the United States Transplant System

Hillary J Braun  1 , Dominic Amara  2 , Amy M Shui  1   3 , Peter G Stock  1 , Ryutaro Hirose  1 , Francis L Delmonico  4 , Nancy L Ascher  1
Affiliations

International Travel for Liver Transplantation: A Comprehensive Assessment of the Impact on the United States Transplant System

Hillary J Braun et al. Transplantation. .

Abstract

Background: International travel for transplantation remains a global issue as countries continue to struggle in establishing self-sufficiency. In the United States, the United Network for Organ Sharing (UNOS) requires citizenship classification at time of waitlisting to remain transparent and understand to whom our organs are allocated. This study provides an assessment of patients who travel internationally for liver transplantation and their outcomes using the current citizenship classification used by UNOS.

Methods: Adult liver UNOS data from 2003 to 2019 were used. Patients were identified as citizens, noncitizen, nonresidents (NCNR), or noncitizen residents (NC-R) according to citizenship status. Descriptive statistics compared demographics among the waitlisted patients and demographics and donor characteristics among transplant recipients. A competing risks model was used to examine waitlist outcomes. The Kaplan-Meier method and Cox proportional hazards were used for posttransplant outcomes.

Results: There were significant demographic differences according to citizenship group among waitlisted (n = 125 652) and transplanted (n = 71 536) patients. Compared with US citizens, NCNR was associated with a 9% increase in transplant (subdistribution hazard ratio [SHR], 1.09; 95% confidence interval [CI], 1.00-1.18; P = 0.04), and NC-R was associated with a 24% decrease in transplant (SHR, 0.76; 95% CI, 0.72-0.79; P < 0.0001) and a 23% increase in death or removal for being too sick (SHR, 1.23; 95% CI, 1.14-1.33; P < 0.0001). US citizens had significantly inferior graft and patient survival (P < 0.001).

Conclusions: Though the purpose of the citizenship classification system is transparency, the results of this study highlight significant disparities in the access to and outcomes following liver transplantation according to citizenship status.

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Conflict of interest statement

The authors declare no conflicts of interest.

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References

    1. HRSA. OPTN waiting list data. Available at https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/# . Published 2018. Accessed September 1, 2019.
    1. Brown S, Savva Y, Barth R, et al. Multiple regional listing increases liver transplant rates for those with model for end-stage liver disease score <15. Transplantation. 2020;104:762–769.
    1. Declaration of Istanbul Custodian Group. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2018 Edition). Transplantation. 2019;103:218–219.
    1. Ambagtsheer F, Van Balen LJ, Duijst-Heesters WL, et al. Reporting organ trafficking networks: a survey-based plea to breach the secrecy oath. Am J Transplant. 2015;15:1759–1767.
    1. 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.

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