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Deceased Donor Organ Transplantation Performed in the United States for Noncitizens and Nonresidents

Delmonico, Francis L., MD1; Gunderson, Susan, MHA1; Iyer, Kishore R., MBBS, FRCS1; Danovitch, Gabriel M., MD1; Pruett, Timothy L., MD1; Reyes, Jorge D., MD1; Ascher, Nancy L., MD, PhD1

doi: 10.1097/TP.0000000000002086
Original Clinical Science—General

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.

The authors analyze the UNOS data regarding citizenship and residency status of all organ recipients within the USA. On top of getting current and accurate data, the authors discuss the potential deleterious consequences for US residents and the applicability to all other countries facing the same issue.

1 Massachusetts General Hospital, Boston, MA.

Received 7 September 2017. Revision received 3 January 2018.

Accepted 3 January 2018.

The authors declare no funding or conflicts of interest.

Please be advised that all authors contributed.

The initial writing was done by F.D. S.G. and N.A. The other authors reviewed the drafts for their revisions. Similarly for the resubmission, F.D., S.G. and N.A. developed draft that each author commented and contributed.

Correspondence: Francis L. Delmonico, MD, 617 413 5311, Massachusetts General Hospital, 55 Fruit Street/White Bldg 505, Boston, MA 02114-2696. (

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