Deceased Donor Organ Transplantation Performed in the United States for Non- Citizens and Non-Residents

Since 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the citizenship and residency status of patients undergoing transplantation in the United States. This policy replaced the 5% threshold of the non-US citizen/non-U.S. residents (NC/NR) undergoing organ transplantation that could result in an audit of transplant center activity. We analyzed the frequency of NC/NR deceased donor organ transplants and wait list registrations at all US transplant centers using data provided by UNOS for that purpose to the UNOS Ad Hoc International Relations Committee. During the period of 2013 – 2016, 1,176 deceased donor transplants (of all organs) were performed in NC/NR candidates (1.2 % of the total number of transplants). There were 5 kidney and 7 liver transplant centers that performed > 5% of the deceased donor kidney and deceased donor liver transplants respectively in NC/NR during the years 2014-2016 with a total of 147 deceased donor kidney transplants and 120 deceased donor liver transplants in 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 US. 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. Corresponding author: Francis L. Delmonico, francis_delmonico@neds.org, 617 413 5311, Massachusetts General Hospital, 55 Fruit Street/White Bldg 505, Boston, Massachusetts, 02114-2696 Please be advised that all authors contributed The initial writing was done by FD SG and NA The other authors reviewed the drafts for their revisions Similarly for the Resubmission FD SG and NA developed draft that each author commented and contributed There is no conflict of interest Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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