Foreign Transplants

[KittyLovinRN]

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?

[KatieMI, BSN, MSN, RN]

Organ transplants are impossible to get in Japan because of cultural beliefs against organ donation. They believe that if the body is still warm, the soul is still present. Japanese citizens have to travel abroad for organ transplants. As long as they meet the same criteria as Americans, and aren't allowed to buy their way to the top of the list (which has happened, and not just in the US), I have no problem with foreigners coming to the US for organ transplants.

Same in Russia - "brain death" criteria are not used, and church and public opinion are both vehemently against any transplants at all. Some minimal number of kidneys from related donors done, for everything else - get money and go West.

[RNsRWe, ASN, RN]

They come here, pay the money for evaluations, hospitalization, hotels and are placed on the list in the same way natural born citizens are. They are not necessarily back ups or anything they're just on the list and when there's a match they get the organ. But I'm torn, what if that lung could go to a teen with cystic fibrosis or that heart to a young woman who's body attacked her heart during pregnancy and is now living on an LVAD?

And how do you know they're not? Being a citizen of the US doesn't increase your need; UNOS will prioritize and the ones in greatest need will get them first.

There is a sad story for the vast majority of people on this list....regardless of where they were born.

[Sadala, ADN, RN]

They come here, pay the money for evaluations, hospitalization, hotels and are placed on the list in the same way natural born citizens are. They are not necessarily back ups or anything they're just on the list and when there's a match they get the organ. But I'm torn, what if that lung could go to a teen with cystic fibrosis or that heart to a young woman who's body attacked her heart during pregnancy and is now living on an LVAD?

I think additionally, people with the $$ can afford to be evaluated by and available to more than one transplant center at the same time. If you can afford to maintain a listing at every tp center in your region then you have a much better chance of having an organ come up.

Insurance, I'm sure, pays for only one tp center.

[Sadala, ADN, RN]

Same in Russia - "brain death" criteria are not used, and church and public opinion are both vehemently against any transplants at all. Some minimal number of kidneys from related donors done, for everything else - get money and go West.

Lots of tps for "related" individuals in India, so I hear.

[nurseprnRN, BSN, RN]

Unfortunately the words "if you do some research" can often be misconstrued as "hey lazy look crap up".

Or in many cases, not misconstrued at all. That IS what it means. :)

Organ donations are prioritized by need, as noted above. If a foreign national wants to pay huge bucks for the work-up, is accepted for transplant, and goes on the wait list, a big honking wad of cash for cost and anticipated expenses for complications gets put in escrow. Then it's the 5% rule.

[BlueDevil,DNP, DNP, RN]

I believe in helping- but I believe in helping our own people first. We gave lots of aid, including money in the tsunami disaster, for example, to help injured and homeless people that were devastated-but we still have sick, hungry, and homeless people here. We give "foreign aid" to countries in the Middle East, but our National Debt is out of control.

So I guess my opinion on the matter is: no, non-US citizens should not be receiving the organs of US citizens, unless, for some reason, there is no one that matches, and the organ could not be used.

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.

[DawnJ]

Plus, we are not transplanting anyone who doesn't have insurance.

Really? If you don't have insurance, no matter how sick you are or why--you just die? That doesn't seem right.

[CrazyCoconut]

The current 5 percent rule for foreigners won't cut it. Wealthy foreigners have, for a long time, "bought their way" into the system, just like wealthy Americans (See Steve Jobs) seeking donated American organs. Likewise, the same can be said for countries like China where foreigners also "buy" into the system for organ procurement (and Americans are also guilty of this). Money and influence is power. And the poor and unfortunate are the ones left to suffer. It's the way of this world.

[dirtyhippiegirl, BSN, RN]

Really? If you don't have insurance, no matter how sick you are or why--you just die? That doesn't seem right.

You'll die anyway if you can't afford to take your anti-rejection meds, follow up extensively with doctors pretty much for the rest of your life, keep on top of your health, etc. Unfortunately, unless you have a wad of cash sitting somewhere, it can be very hard to keep up with the requirements needed to maintain a donated organ unless you have private insurance. Socio-economic issues play a huge part in the initial donation evaluation.

[Kunzieo]

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 your response to be naive at best. 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?

I consider being a citizen of a country sort of like being part of a family. You have responsibility toward each other first.

And do you think other countries do not feel the same way? If you asked people from France, Russia, South Korea, Argentina, Australia, Japan, Mexico, etc. I think they would all agree that in THEIR country, THEIR citizens have priority over any foreign visitors when it comes to health and safety.

[elkpark]

Really? If you don't have insurance, no matter how sick you are or why--you just die? That doesn't seem right.

Welcome to the good ol' US of A ...

I'm imagining that it is probably safer to get these transplants in the US than whenever the patient is coming from.

These people are the elite from around the world... and they're on multiple transplant lists and simply fly to wherever they can get an organ.

I thought that potential transplant recipients were prioritized according to greatest need? Could be wrong on that though.

Yes, within the region of the transplant center. The wealthy people are able to be on multiple lists because they have the means to get themselves wherever they need to go in order to get their transplant.

That's what Steve Jobs did... a benefit of having a private jet at your disposal...