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Kidney Week

Abstract: FR-PO796

Promoting Transplant Equity: Characterizing Deceased Organ Donation by Noncitizens in the United States

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Rizzolo, Katherine M., Boston Medical Center, Boston, Massachusetts, United States
  • Schold, Jesse D., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
  • Cervantes, Lilia, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Background

There are no citizenship restrictions to receiving or donating a kidney transplant per the United Network for Organ Sharing and the Organ Procurement Transplantation Network. However, the major barrier to transplant for most undocumented immigrants are insurance barriers as undocumented immigrants are barred from receiving federal insurance. Non-citizens are aware of the double standard allowing them to donate organs despite the restrictions to receiving them. Restricting access to organ transplant pool while being able to contribute to it is inequitable. However, the degree of contribution to the organ pool by non-citizens has not been recently assessed. The aim of this study is to illustrate the degree to which non-citizens contribute to the organ pool in the US between 2015 and 2020.

Methods

We utilized UNOS data examining decreased organ donors in the US between 2015 and 2020. To summarize recipient and donor characteristics, median and interquartile range (IQR) were used for continuous variables and counts and percents were used for categorical variables. Characteristics were stratified by reported citizenship status. To test for differences across groups, ANOVA (for normally distributed) or Kruskal-Wallis (non-normally distributed) tests were used for continuous variables after testing for normality via the Shapiro-Wilk test and Chi-square tests were used for categorical variables.

Results

Non-US Citizen/US Residents (NCR) accounted for 2.8% and Non-US Citizens/Non-US Residents (NCNR) accounted for 0.4% of the donor population. Compared with US citizens, non-citizen residents were more likely to be older, male, O blood type and have diabetes. Regarding citizenship status of donors and recipients, 91% of NCR and 90% of NCNR organs (n=5581) were received by US citizens. 5.8% of organs (n=9172) donated by US citizens were received by NCR or NCNR recipients.

Conclusion

There are no citizenship restrictions on organ donation from deceased individuals, however, restrictions on federal insurance is a barrier to transplant for non-citizens. We illustrate that non-citizens donate healthy, viable organs to the US organ pool, the majority of which are received by US citizens. Any system that uses these gifts from individuals who would themselves not be considered eligible for an organ transplant is unjust.

Funding

  • NIDDK Support – Davita