Foreign Transplants

Hoozdo, ADN · May 3, 2013

My liver transplant story exactly mirrors you Mom's

. My husband has always been a blood donor and Red Cross informed him he couldn't donate blood anymore.

Just wanted to let you know that the Red Cross recently lifted that restriction banning spouses of HCv+ individuals. My husbad is now donating again!

Home Health Columnist / Guide · May 3, 2013

Go to the source for data on organ transplantation: United Network for Organ Sharing

National Data >

Includes the latest data about the status of U.S. organ donation and transplantation on a national level.

Donor Matching System

When transplant hospitals accept patients onto the waiting list, the patients are registered in a centralized, national computer network that links all donors and transplant candidates. The UNOS Organ Center is staffed 24 hours a day throughout the year, and it assists with the matching, sharing and transportation of organs via this computer network.

Transplant centers, tissue typing laboratories, and OPOs are involved in the organ sharing process. When donor organs are identified, the procuring organization typically accesses the computerized organ matching system, enters information about the donor organs, and runs the match program. At times, when requested or when there is a need to identify perfectly matched kidney donor/recipients, the matching process is handled by Organ Center personnel at UNOS headquarters in Richmond, Virginia.

For each organ that becomes available, the computer program generates a list of potential recipients ranked according to objective criteria (i.e. blood type, tissue type, size of the organ, medical urgency of the patient, time on the waiting list, and distance between donor and recipient). Each organ has its own specific criteria. Ethnicity, gender, religion, and financial status are not part of the computer matching system.

After printing the list of potential recipients, the procurement coordinator contacts the transplant surgeon caring for the top-ranked patient (i.e. patient whose organ characteristics best match the donor organ and whose time on the waiting list, urgency status, and distance from the donor organ adhere to allocation policy) to offer the organ. Depending on various factors, such as the donor's medical history and the current health of the potential recipient, the transplant surgeon determines if the organ is suitable for the patient. If the organ is turned down, the next listed individual's transplant center is contacted, and so on, until the organ is placed.

Once the organ is accepted for a potential recipient, transportation arrangements are made for the surgical teams to come to the donor hospital and surgery is scheduled. For heart, lung, or liver transplantation, the recipient of the organ is identified prior to the organ recovery and called into the hospital where the transplant will occur to prepare for the surgery.

The recovered organs are stored in a cold organ preservation solution and transported from the donor to the recipient hospital. For heart and lung recipients, it is best to transplant the organ within six hours of organ recovery. Livers can be preserved up to 24 hours after recovery. For kidneys and typically the pancreas, laboratory tests designed to measure the compatibility between the donor organ and recipient are performed. A surgeon will not accept the organ if these tests show that the patient's immune system will reject the organ. Therefore, the recipient is usually not identified until after these organs are recovered.

OPTN Policy 6 - Transplantation of non-resident aliens

Ethics:

Organ Transplantation - The Hastings Center

Distributing Organs: What Is Just and Fair?
Rationing is unavoidable in organ transplantation, but the system for allocating organs must be just and fair. Justice requires some rule or policy that insures that the supply of donated organs is used wisely and consistently with what donors and their families would wish, such as giving priority to saving children’s lives, or to American citizens. Fairness demands that like cases be treated alike and that the allocation system be transparent, so that all who wait know why some are selected and some are not.
There are valid questions about the justice and fairness of the current system. Transplant centers are the gatekeepers who decide whom they will and will not admit as transplant candidates. Their policies vary. Many nonmedical values shape their decisions, and it can be argued that some centers invoke these values in ways that are not truly just. Among these considerations:
Many transplant centers will not accept people without insurance.
Transplant teams rarely consider anyone over 75 years of age.
Some centers exclude patients with moderate mental retardation, HIV, a history of addiction, or a long criminal record.
Though American transplant centers can list foreigners, they can make up no more than 5% of any center’s list. Most of non–U.S. citizens listed have substantial financial resources and pay in cash.
Some transplant programs will admit illegal aliens, but most are children. Some transplant centers have caused controversy by refusing to retransplant illegal aliens whose initial organs, received at the same hospital during childhood, have failed.
...—a practice known as multiple listing. About 10% of the current waiting list consists of persons who are listed at more than one center. Critics of multiple listing say that it is unjust because it gives an advantage to people with the resources to pay for more than one evaluation and listing. Each evaluation can cost tens of thousands of dollars....

BlueDevil,DNP, DNP, RN · May 4, 2013

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.

I didn't realize you were referring to live donor transplants for beloved friends/relatives. That is an entirely different matter. I would respect your right to decision not to donate a kidney to a stranger simply because you happened to be a match; I do not believe one is under any ethical or moral obligation to give away body parts while they are still in use, lol.

I thought we were discussing the OPTNs for donations between strangers, in which case, "all men are created equal" and individuals ought to be evaluated on basis of need, clearly. There is obviously no other ethical way to approach the matter.