Foreign Transplants

Nurses General Nursing

Published

Happy Monday everyone!

I had a thought run through my mind this morning as I was heading out the door to see my patients (I work home health in a large city, servicing many out of town patients). I have been seeing many patients from outside the US coming here to receive organ transplants. I'm conflicted on this practice as the organs they receive could be going to someone here but at the same time I acknowledge that all life deserves care and treatment.

What are your thoughts? Should big wads of cash be accepted for placement on our transplant lists?

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Large transplant centers have foreign nationals on their transplant list though the number is small as previously quoted. These are individuals who pay in cash for the entire duration of services and have the resources to maintain follow-up. Yes, relatives of Saudi royalty have been recipients. Undocumented aliens sometimes present in fulminant organ failure to the point that their condition qualifies for organ transplantation. However, organ transplantation requires a thorough evaluation of psycho-social status to maintain adherence to a strict post-operative routine for the long haul. This disqualifies majority of these individuals. Our facility has seen both cases of pre-transplant patients.

Specializes in Nephrology, Cardiology, ER, ICU.

I work in nephrology and we currently do kidney and kidney-pancreas tx. Neither of these organs are transplanted on the basis of need, but rather just a waiting period. Renal failure pts can be maintained on dialysis and DM is treatable too.

The current wait in my system is 4-5 years for a kidney, 3-5 years for K-P.

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
The current wait in my system is 4-5 years for a kidney, 3-5 years for K-P.

Wow. That's amazing. I would never have guessed the wait is that long.

Specializes in Pulmonary, Lung Transplant, Med/Surg.

Wow. That's amazing. I would never have guessed the wait is that long.

Lungs however aren't nearly that long for the most part. I always inquire how old my patients lungs are and how long they waited. The large hosp system in my city lists later in disease process it seems (ie pulmonary fibrosis, pulm hypertension, CF).

Anyway! I've seen a range from 6 days to 14 months for lungs, and obviously people have waiting longer than 14 months but I've seen really short wait times once listed more often than not. Kidneys and KPs are tough though!

...... Let's say you are in this situation: a close family member is in need of an organ, say a kidney. You are a good match. You also are an equally good match with someone you have never met who lives across the country. Who gets the kidney?

.

My close family member, not the stranger. I, as the donor, can direct the donation to whomever I choose. The list would not apply.

Lungs however aren't nearly that long for the most part.

That's because you can live a lot longer waiting on the kidney. A wait that long for a lung and you've dropped off the list because your dead, not because you got the lung.

Specializes in Pulmonary, Lung Transplant, Med/Surg.

That's because you can live a lot longer waiting on the kidney. A wait that long for a lung and you've dropped off the list because your dead, not because you got the lung.

True story

I find this distasteful, to put it mildly. It implies that American lives are worth more than others. If the potential recipient can meet the terms of the transplant guidelines and bear the costs, then one's country of origin should be irrelevant. Considering one's nationality as criteria is as repugnant as considering race or gender.
I find it quite distasteful, to put it mildly, that ones insurance status is a primary decider whether a person is placed on the list at all.

We solicit organs from people who themselves would be denied them only because they have not the financial means to pay for it.

I also find it distasteful, to put it mildly, that one may receive an organ regardless of whether they're registered as an organ donor themselves.

It is this last point which causes my discomfort with permitting the wealthy from other countries to fly here to obtain what they cannot get in their home country.

If one is not themselves an organ donor, they should be excluded from the list.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
If one is not themselves an organ donor they should be excluded from the list.[/quote']My mother contracted the hepatitis C virus after having received a tainted blood transfusion in the early 1980s. She eventually developed end-stage liver disease and received a liver transplantation eleven years ago.

Anyhow, my mother is banned from being an organ donor because of her exposure to hepatitis C. And I was banned by a local blood bank from donating my blood because I shared living quarters with my HCV+ parents for more than one year.

My point is that some people want to donate, but prudent policies prevent many of them from doing so.

My point is that some people want to donate, but prudent policies prevent many of them from doing so.
Your point is well taken though I'm speaking more of the people who refuse to participate in the program due to ignorance, laziness, selfishness, or fear... or people from other countries who are not potential donors.

If one is not themselves an organ donor, they should be excluded from the list.

So children should be excluded?

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
That's because you can live a lot longer waiting on the kidney. A wait that long for a lung and you've dropped off the list because your dead, not because you got the lung.

Actually of all solid organs transplant candidates, only end-stage liver disease patients end up waiting with no alternative treatment modality but to constantly receive transfusions of blood products to reverse coagulopathy, prevent spontaneous bacterial peritonitis, as well as give medications to manage hepatic encephalopathy.

Our facility is a multi-organ transplant center. Those waiting for hearts can be bridged with an implantable ventricular assist device. Those waiting for kidneys can remain on dialysis. Those waiting for simultaneous kidney-pancreas can be on dialysis and insulin pump. Recently, end stage lung disease patients who decompensate are now being bridged with ECMO. Of course, not all centers are able to do that. In our experience, patients who are very motivated can maintain mobility on ECMO while waiting for a donor lung. They stay in the hospital waiting for the organ but the fact that they are on ECMO bumps them up on the Lung Allocation Score and puts them on top of the lung transplant list.

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