washingtonpost.com U.S. Citizens Get More Organs Than They Give
Donations From Foreign Residents on the Rise
By Shankar Vedantam
Washington Post Staff Writer
Monday, March 3, 2003; Page A03
The whispers started as soon as Jesica Santillan was declared dead nine days ago. Should two sets of hearts and lungs -- considered the scarcest transplantable organs -- have gone to an illegal immigrant?
But American citizens are more likely to benefit from organs donated by noncitizens than the other way around, according to the nation's coordinating transplant agency.
"As a percentage, every year, U.S. citizens receive more organs than they donate," said Anne Paschke, a spokeswoman for the United Network for Organ Sharing (UNOS), which links organ donors with recipients nationwide.
In 2001, the last complete year for which statistics are available, U.S. citizens received 96.2 percent of the transplants in the country, Paschke said. By contrast, 94.8 percent of organ donors were citizens. The rest were permanent residents, nonresident foreigners and others, she said, and statistics going back more than a decade indicate the trend has held constant.
Santillan, a 17-year-old from Mexico, became widely known after Duke University doctors gave her mismatched organs last month. The case has trained a spotlight on medical errors and has led some to question whether scarce organs in the United States ought to go to foreigners, especially those who are in the country illegally. Santillan's family smuggled her into the country to get treatment for a chronic heart problem.
Santillan took organs out of the system, but the percentage of organ donors who are permanent residents has increased steadily in recent years. The rise could be a consequence of outreach efforts to encourage donation, particularly in the Hispanic community, Paschke said.
In 1998, green-card holders donated only 0.1 percent of organs in the country. That rose to 1 percent in 1999, 2.4 percent in 2000 and 2.8 percent in 2001, according to UNOS. Permanent residents receive about 2.3 percent of transplants each year.
Mixing politics, nationality and medicine makes doctors and the transplant network uncomfortable. Organ donation is an act of altruism, and the transplant community is loath to make anyone, citizen or noncitizen, reluctant to donate their organs after death.
"From a humanitarian perspective, it would be difficult for a physician in the U.S. to turn those people away who are in need," said Kenneth R. McCurry, director of lung and heart-lung transplants at the University of Pittsburgh Medical Center. "We shouldn't take this isolationist approach from a health care perspective that we can't allow non-U.S.-citizens to participate."
UNOS imposes a limit on how many organs from its system can be transplanted into foreigners who enter the country specifically to get medical care and into illegal immigrants, such as Santillan. In a year, no center may transplant more than 5 percent of organs into such patients. There are no limits on organ donations by noncitizens.
Although the recent case has highlighted the ethical dilemma posed to doctors when a desperately ill teenager arrives at a hospital's doorstep -- pitting the responsibility of doctors to care for the sick against rules limiting transplants to illegal immigrants -- cases such as Santillan's are the exception, not the rule.
Most foreign patients who receive U.S. transplants are referred by doctors in their home countries, McCurry said. A hospital then determines whether it can admit the patient without going beyond the 5 percent limit. If not, the hospital suggests the patient look elsewhere.
Officials at UNOS say there have been no serious violations of the rule. An internal committee composed of transplant surgeons, federal administrators and transplant activists examines any hospital that exceeds 5 percent to make sure it is not bringing in more than the allowed proportion of patients from other countries in order, for example, to make money from wealthy foreign patients.
Hospitals are viewed more leniently if they do a small number of transplants -- a center that does only 10 transplants of a particular organ would violate the rule if it offered even one transplant to someone like Santillan, because that would be 10 percent of its total, said Jorge Reyes, a member of the committee and the director of transplants at the Children's Hospital of Pittsburgh.
Ultimately, Reyes and others said, the way to make organs available for the many Americans on waiting lists is to increase organ donation in the United States and to help create expertise in other countries that would allow patients like Santillan to be treated in Mexico, rather than in North Carolina.
Programs to train surgeons and to establish networks that collect and distribute organs are now widespread in Europe, greatly diminishing the number of European patients who come to the United States, Reyes said.
The majority of foreign patients who enter the United States for transplants are now from Central and Latin America.
© 2003 The Washington Post Company
Donations From Foreign Residents on the Rise
By Shankar Vedantam
Washington Post Staff Writer
Monday, March 3, 2003; Page A03
The whispers started as soon as Jesica Santillan was declared dead nine days ago. Should two sets of hearts and lungs -- considered the scarcest transplantable organs -- have gone to an illegal immigrant?
But American citizens are more likely to benefit from organs donated by noncitizens than the other way around, according to the nation's coordinating transplant agency.
"As a percentage, every year, U.S. citizens receive more organs than they donate," said Anne Paschke, a spokeswoman for the United Network for Organ Sharing (UNOS), which links organ donors with recipients nationwide.
In 2001, the last complete year for which statistics are available, U.S. citizens received 96.2 percent of the transplants in the country, Paschke said. By contrast, 94.8 percent of organ donors were citizens. The rest were permanent residents, nonresident foreigners and others, she said, and statistics going back more than a decade indicate the trend has held constant.
Santillan, a 17-year-old from Mexico, became widely known after Duke University doctors gave her mismatched organs last month. The case has trained a spotlight on medical errors and has led some to question whether scarce organs in the United States ought to go to foreigners, especially those who are in the country illegally. Santillan's family smuggled her into the country to get treatment for a chronic heart problem.
Santillan took organs out of the system, but the percentage of organ donors who are permanent residents has increased steadily in recent years. The rise could be a consequence of outreach efforts to encourage donation, particularly in the Hispanic community, Paschke said.
In 1998, green-card holders donated only 0.1 percent of organs in the country. That rose to 1 percent in 1999, 2.4 percent in 2000 and 2.8 percent in 2001, according to UNOS. Permanent residents receive about 2.3 percent of transplants each year.
Mixing politics, nationality and medicine makes doctors and the transplant network uncomfortable. Organ donation is an act of altruism, and the transplant community is loath to make anyone, citizen or noncitizen, reluctant to donate their organs after death.
"From a humanitarian perspective, it would be difficult for a physician in the U.S. to turn those people away who are in need," said Kenneth R. McCurry, director of lung and heart-lung transplants at the University of Pittsburgh Medical Center. "We shouldn't take this isolationist approach from a health care perspective that we can't allow non-U.S.-citizens to participate."
UNOS imposes a limit on how many organs from its system can be transplanted into foreigners who enter the country specifically to get medical care and into illegal immigrants, such as Santillan. In a year, no center may transplant more than 5 percent of organs into such patients. There are no limits on organ donations by noncitizens.
Although the recent case has highlighted the ethical dilemma posed to doctors when a desperately ill teenager arrives at a hospital's doorstep -- pitting the responsibility of doctors to care for the sick against rules limiting transplants to illegal immigrants -- cases such as Santillan's are the exception, not the rule.
Most foreign patients who receive U.S. transplants are referred by doctors in their home countries, McCurry said. A hospital then determines whether it can admit the patient without going beyond the 5 percent limit. If not, the hospital suggests the patient look elsewhere.
Officials at UNOS say there have been no serious violations of the rule. An internal committee composed of transplant surgeons, federal administrators and transplant activists examines any hospital that exceeds 5 percent to make sure it is not bringing in more than the allowed proportion of patients from other countries in order, for example, to make money from wealthy foreign patients.
Hospitals are viewed more leniently if they do a small number of transplants -- a center that does only 10 transplants of a particular organ would violate the rule if it offered even one transplant to someone like Santillan, because that would be 10 percent of its total, said Jorge Reyes, a member of the committee and the director of transplants at the Children's Hospital of Pittsburgh.
Ultimately, Reyes and others said, the way to make organs available for the many Americans on waiting lists is to increase organ donation in the United States and to help create expertise in other countries that would allow patients like Santillan to be treated in Mexico, rather than in North Carolina.
Programs to train surgeons and to establish networks that collect and distribute organs are now widespread in Europe, greatly diminishing the number of European patients who come to the United States, Reyes said.
The majority of foreign patients who enter the United States for transplants are now from Central and Latin America.
© 2003 The Washington Post Company
