Social
Citizenship in Organ Procurement and Transplantation Network Data in 2022 Jesse Howell* Jesse Howell Tamika Watkins Peter Stock Pramod Bonde
Background: The Organ Procurement and Transplantation Network (OPTN) Ad Hoc International Relations Committee (AHIRC) examines citizenship data for transplant candidates and recipients in their annual report. This report does not contain data on organ donors, and the committee expressed interest in examining donor data to supplement the report data.
Methods: We evaluated OPTN data collected in 2022 for waitlist (WL) registrations, transplanted recipients, and deceased organ donors (dd), and removed those with missing citizenship. Citizenship categories included: U.S. citizen, non-U.S. citizen/U.S. resident, and non-U.S. citizen/non-U.S. resident (NCNR), which was split into those who came to the U.S. for the purpose of transplant (NCNR-tx) and for a reason other than transplant (NCNR-oth). Those listed before 2012 used non-resident alien (NRA) rather than NCNR. Dd had an additional citizenship option of “unknown”.
Results: In 2022, 68,099 adult and pediatric solid organ registrations were added to the WL. Of those, 1.5% were NCNR candidates, including 773 NCNR-oth and 225 NCNR-tx. There were 36,415 solid organ dd transplants in 2022 and 1.5% were to NCNR recipients, including 404 NCNR-oth, 125 NCNR-tx, and 4 NRA. Of all dd in 2022, 0.5% (n=81) were NCNR and 5.8% (n=865) had unknown citizenship.
Conclusion: There was no difference in the proportion of NCNR WL registrations and dd transplant recipients, but comparing to dd is difficult as almost 6% had unknown citizenship. In 2021, a proposal was released to remove the citizenship question from dd forms citing challenges in collecting this data from donor families. This was ultimately not pursued due to pushback, including from IRC, which suggested that the community needed to be better informed on why this data is collected and what it is used for. They also advised providing clarity on citizenship data elements to ensure less variation in how programs respond. These results support those recommendations.