Deceased donor kidney and liver transplantation to nonresident aliens in the United States

[Guest guest]

Transplantation. 2007 Dec 27;84(12):1548-56.

Deceased donor kidney and liver transplantation to nonresident aliens in the

United States.

Schold JD, Meier-Kriesche HU, Duncan RP, AI.

1 Department of Medicine, University of Florida, Gainesville, FL. 2 Health

Services Research, Management, and Policy, University of Florida, Gainesville,

FL. 3 Department of Surgery, University of Florida, Gainesville, FL.

BACKGROUND.: Policies governing the allocation of deceased donor organs to

nonresident aliens (NRAs) have existed from the early days of transplantation.

However, there is a paucity of research describing this population. The aim of

the present study is to examine characteristics and allocation patterns for NRAs

compared to U.S. citizens in the context of the two most common forms of solid

organ transplantation. METHODS.: The study included kidney and liver transplant

candidates and deceased donor transplant recipients from 1988-2005 in the United

States. We describe demographic characteristics, insurance coverage, geographic

variability, and donor relationship based on citizenship and residency status.

We additionally examined the association of citizenship with time to

transplantation utilizing survival models. RESULTS.: From 1988-2005, there were

2724 solitary kidney and 2072 liver NRA candidate listings with United Network

for Organ Sharing. NRA recipients had more self-pay (liver 36% and kidney 22%)

and foreign sources (liver 26% and kidney 13%) of insurance coverage.

Transplants to NRAs were more frequent than deceased donations deriving from

NRAs for both organs. Adjusted models indicated that NRA kidney candidates

received transplants at the same rate as U.S. citizens while liver NRA

candidates received transplants more rapidly during the pre-Model for End-Stage

Liver Disease (MELD; adjusted hazard ratio [AHR] 1.2, confidence interval [CI]

1.2-1.3) and post-MELD (AHR 1.5, CI 1.3-1.7) eras. CONCLUSIONS.: NRAs are

demographically and socioeconomically diverse and have historically had a more

rapid progression on the waiting list to receive a liver transplant. Further

discussion and investigation concerning the ethical, economic, and public health

ramifications of transplantation to NRA patients are warranted.

PMID: 18165761 [PubMed - in process]

_________________________________________________________________

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[Guest guest]

Transplantation. 2007 Dec 27;84(12):1548-56.

Deceased donor kidney and liver transplantation to nonresident aliens in the

United States.

Schold JD, Meier-Kriesche HU, Duncan RP, AI.

1 Department of Medicine, University of Florida, Gainesville, FL. 2 Health

Services Research, Management, and Policy, University of Florida, Gainesville,

FL. 3 Department of Surgery, University of Florida, Gainesville, FL.

BACKGROUND.: Policies governing the allocation of deceased donor organs to

nonresident aliens (NRAs) have existed from the early days of transplantation.

However, there is a paucity of research describing this population. The aim of

the present study is to examine characteristics and allocation patterns for NRAs

compared to U.S. citizens in the context of the two most common forms of solid

organ transplantation. METHODS.: The study included kidney and liver transplant

candidates and deceased donor transplant recipients from 1988-2005 in the United

States. We describe demographic characteristics, insurance coverage, geographic

variability, and donor relationship based on citizenship and residency status.

We additionally examined the association of citizenship with time to

transplantation utilizing survival models. RESULTS.: From 1988-2005, there were

2724 solitary kidney and 2072 liver NRA candidate listings with United Network

for Organ Sharing. NRA recipients had more self-pay (liver 36% and kidney 22%)

and foreign sources (liver 26% and kidney 13%) of insurance coverage.

Transplants to NRAs were more frequent than deceased donations deriving from

NRAs for both organs. Adjusted models indicated that NRA kidney candidates

received transplants at the same rate as U.S. citizens while liver NRA

candidates received transplants more rapidly during the pre-Model for End-Stage

Liver Disease (MELD; adjusted hazard ratio [AHR] 1.2, confidence interval [CI]

1.2-1.3) and post-MELD (AHR 1.5, CI 1.3-1.7) eras. CONCLUSIONS.: NRAs are

demographically and socioeconomically diverse and have historically had a more

rapid progression on the waiting list to receive a liver transplant. Further

discussion and investigation concerning the ethical, economic, and public health

ramifications of transplantation to NRA patients are warranted.

PMID: 18165761 [PubMed - in process]

_________________________________________________________________

Watch “Cause Effect,” a show about real people making a real difference.

http://im.live.com/Messenger/IM/MTV/?source=text_watchcause

[Guest guest]

Transplantation. 2007 Dec 27;84(12):1548-56.

Deceased donor kidney and liver transplantation to nonresident aliens in the

United States.

Schold JD, Meier-Kriesche HU, Duncan RP, AI.

1 Department of Medicine, University of Florida, Gainesville, FL. 2 Health

Services Research, Management, and Policy, University of Florida, Gainesville,

FL. 3 Department of Surgery, University of Florida, Gainesville, FL.

BACKGROUND.: Policies governing the allocation of deceased donor organs to

nonresident aliens (NRAs) have existed from the early days of transplantation.

However, there is a paucity of research describing this population. The aim of

the present study is to examine characteristics and allocation patterns for NRAs

compared to U.S. citizens in the context of the two most common forms of solid

organ transplantation. METHODS.: The study included kidney and liver transplant

candidates and deceased donor transplant recipients from 1988-2005 in the United

States. We describe demographic characteristics, insurance coverage, geographic

variability, and donor relationship based on citizenship and residency status.

We additionally examined the association of citizenship with time to

transplantation utilizing survival models. RESULTS.: From 1988-2005, there were

2724 solitary kidney and 2072 liver NRA candidate listings with United Network

for Organ Sharing. NRA recipients had more self-pay (liver 36% and kidney 22%)

and foreign sources (liver 26% and kidney 13%) of insurance coverage.

Transplants to NRAs were more frequent than deceased donations deriving from

NRAs for both organs. Adjusted models indicated that NRA kidney candidates

received transplants at the same rate as U.S. citizens while liver NRA

candidates received transplants more rapidly during the pre-Model for End-Stage

Liver Disease (MELD; adjusted hazard ratio [AHR] 1.2, confidence interval [CI]

1.2-1.3) and post-MELD (AHR 1.5, CI 1.3-1.7) eras. CONCLUSIONS.: NRAs are

demographically and socioeconomically diverse and have historically had a more

rapid progression on the waiting list to receive a liver transplant. Further

discussion and investigation concerning the ethical, economic, and public health

ramifications of transplantation to NRA patients are warranted.

PMID: 18165761 [PubMed - in process]

_________________________________________________________________

Watch “Cause Effect,” a show about real people making a real difference.

http://im.live.com/Messenger/IM/MTV/?source=text_watchcause

[Guest guest]

Transplantation. 2007 Dec 27;84(12):1548-56.

Deceased donor kidney and liver transplantation to nonresident aliens in the

United States.

Schold JD, Meier-Kriesche HU, Duncan RP, AI.

1 Department of Medicine, University of Florida, Gainesville, FL. 2 Health

Services Research, Management, and Policy, University of Florida, Gainesville,

FL. 3 Department of Surgery, University of Florida, Gainesville, FL.

BACKGROUND.: Policies governing the allocation of deceased donor organs to

nonresident aliens (NRAs) have existed from the early days of transplantation.

However, there is a paucity of research describing this population. The aim of

the present study is to examine characteristics and allocation patterns for NRAs

compared to U.S. citizens in the context of the two most common forms of solid

organ transplantation. METHODS.: The study included kidney and liver transplant

candidates and deceased donor transplant recipients from 1988-2005 in the United

States. We describe demographic characteristics, insurance coverage, geographic

variability, and donor relationship based on citizenship and residency status.

We additionally examined the association of citizenship with time to

transplantation utilizing survival models. RESULTS.: From 1988-2005, there were

2724 solitary kidney and 2072 liver NRA candidate listings with United Network

for Organ Sharing. NRA recipients had more self-pay (liver 36% and kidney 22%)

and foreign sources (liver 26% and kidney 13%) of insurance coverage.

Transplants to NRAs were more frequent than deceased donations deriving from

NRAs for both organs. Adjusted models indicated that NRA kidney candidates

received transplants at the same rate as U.S. citizens while liver NRA

candidates received transplants more rapidly during the pre-Model for End-Stage

Liver Disease (MELD; adjusted hazard ratio [AHR] 1.2, confidence interval [CI]

1.2-1.3) and post-MELD (AHR 1.5, CI 1.3-1.7) eras. CONCLUSIONS.: NRAs are

demographically and socioeconomically diverse and have historically had a more

rapid progression on the waiting list to receive a liver transplant. Further

discussion and investigation concerning the ethical, economic, and public health

ramifications of transplantation to NRA patients are warranted.

PMID: 18165761 [PubMed - in process]

_________________________________________________________________

Watch “Cause Effect,” a show about real people making a real difference.

http://im.live.com/Messenger/IM/MTV/?source=text_watchcause