Crossing national borders for transplantation: A focused evaluation of deceased donor lung exports from the United States.

Organ transplantation is a life-saving treatment for end-stage organ failure patients, but the US faces a shortage of available organs. US policies incentivize identifying recipients for all recovered organs. Technological advancements have extended donor organ viability, creating new opportunities for long-distance transport and international sharing. We aimed to assess organ exports from deceased US donors to candidates abroad, a component of allocation policy allowed without suitable domestic candidates. Based on national SRTR data from January 2014-September 2023, 388,342 organs were recovered for transplantation, with 511(0.13%) exported. Most exported organs were lungs(80%). Exported lung donors were older(41 vs. 34 years,p<0.001), more likely Hepatitis-C positive(22% vs. 4%,p<0.001), and more likely donors after circulatory death(20% vs 7%,p<0.001). Lungs that were eventually exported were offered to more US PTRs (median=65) than those kept in the US(median=21 and 41 for lungs recovered by non-exporting and exporting OPOs;p<0.001). Our study highlights the necessity for further research and clear policy initiatives to balance the benefits of cross-border sharing while considering potential opportunities for more aggressive organ allocation within the US.

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Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jesse Schold reports a relationship with Gift of Life Foundation that includes: funding grants. Jesse Schold reports a relationship with One Legacy Foundation that includes: funding grants. Jesse Schold reports a relationship with National Institutes of Health that includes: funding grants. Jesse Schold reports a relationship with Kidney Transplant Collaborative that includes: funding grants. Jesse Schold reports a relationship with eGenesis that includes: consulting or advisory. Jesse Schold reports a relationship with Sanofi that includes: consulting or advisory. Jesse Schold reports a relationship with US Department of Defense that includes: funding grants. Rocio Lopez reports a relationship with Gift of Life Foundation that includes: funding grants. Rocio Lopez reports a relationship with One Legacy Foundation that includes: funding grants. Sumit Mohan reports a relationship with Kidney Transplant Collaborative that includes: funding grants. Sumit Mohan reports a relationship with National Institutes of Health that includes: funding grants. Sumit Mohan reports a relationship with Sanofi that includes: consulting or advisory. Sumit Mohan reports a relationship with Specialist Direct that includes: consulting or advisory. Sumit Mohan reports a relationship with Health Services Advisory Group Inc that includes: consulting or advisory. Sumit Mohan is Chair of the Data Advisory Committee. Jesse Schold is Vice-Chair of the Data Advisory Committee. Jesse Schold is a Statistical Editor for the American Journal of Transplantation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.