International Travel for Organ Transplantation: A Survey of Professional Experiences and Attitudes Toward Data Collection and Reporting.

Background: Lack of data regarding international travel for organ transplantation (ITOT) hampers efforts to evaluate, understand, and respond to trends in ITOT activities, such as those suggestive of organ trafficking or "transplant tourism." This study aimed to assess transplant professionals' experience of ITOT and their attitudes toward reporting ITOT data to a global registry. Methods: An international cross-sectional anonymous survey of transplant professionals was conducted online (from October to December 2022). The English language questionnaire assessed professional experiences in providing care to individuals who had traveled to or from a country for living donation or transplantation, and attitudes toward reporting of ITOT data. Data were analyzed with descriptive statistics. Results: Two hundred thirty-nine individuals from 68 countries completed the entire questionnaire, of whom 79% had provided care for ≥1 patient who had traveled internationally for donation or transplantation. Of these, 60.8% of individuals (n = 115) had cared for ≥1 person who engaged in ITOT between 2019 and 2022, with the most recent case experiences involving 89 countries and 157 unique routes of international travel. Predominant concerns regarding reporting of ITOT data to a global registry related to prevention of harm and protection of patient privacy; most (52.7%; n = 126) respondents expressed a preference for anonymous reporting of ITOT data. Conclusions: ITOT is a global phenomenon and transplant professionals' experience with ITOT cases is more common than anticipated. Systems for the collection of ITOT activity data should be carefully designed to address potential ethical concerns of transplant professionals which may influence reporting practices.

Ethical Aspects of Kidney Donation and Transplantation for Migrants.

Migrants represent a large and diverse population globally that includes international refugees, stateless persons, expatriate workers, and more. Many migrants face significant barriers in accessing health care, especially scarce and costly resources such as dialysis and kidney transplantation. Improving equity of access to these kidney replacement therapies for migrant populations may present a range of complex ethical dilemmas, particularly in the setting of crises and when considering the use of residency status and citizenship as eligibility criteria for access to treatment. In this article, we discuss ethical obligations to provide kidney care for migrants, the implications of the self-sufficiency concept with regard to access to deceased donation and transplantation, factors that may influence evaluation of the risks and benefits of transplantation for migrants with insecure access to care, and the vulnerability of migrants to organ trafficking. We also present a set of general recommendations to assist in preventing and managing ethical dilemmas when making decisions about policy or practice regarding kidney care for migrants.

The Reality of Inadequate Patient Care and the Need for a Global Action Framework in Organ Donation and Transplantation.

BACKGROUND: Transplant therapy is considered the best and often the only available treatment for thousands of patients with organ failure that results from communicable and noncommunicable diseases. The number of annual organ transplants is insufficient for the worldwide need. METHODS: We elaborate the proceedings of the workshop entitled "The Role of Science in the Development of International Standards of Organ Donation and Transplantation," organized by the Pontifical Academy of Sciences and cosponsored by the World Health Organization in June 2021. RESULTS: We detail the urgency and importance of achieving national self-sufficiency in organ transplantation as a public health priority and an important contributor to reaching relevant targets of the United Nations Agenda for Sustainable Development. It details the elements of a global action framework intended for countries at every level of economic development to facilitate either the establishment or enhancement of transplant activity. It sets forth a proposed plan, by addressing the technical considerations for developing and optimizing organ transplantation from both deceased and living organ donors and the regulatory oversight of practices. CONCLUSIONS: This document can be used in governmental and policy circles as a call to action and as a checklist for actions needed to enable organ transplantation as treatment for organ failure.