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Should Transplantation Be Offered to Pediatric Foreign Nationals?

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Ethical Issues in Pediatric Organ Transplantation

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 66))

Abstract

The provision of medical care, and particularly organ transplantation, to foreign nationals (i.e. non-citizens and non-residents) is a matter of heated debate in many countries. Worldwide, the practices regarding the provision of transplantation services to foreign nationals vary enormously. Developed countries with transplant programs often receive requests to list foreign nationals for transplantation. This chapter will explore (1) international practices and policies, (2) arguments for and against transplantation for foreign nationals, (3) whether or not there are morally relevant distinctions between children and adult foreign nationals, and (4) whether or not there are morally relevant distinctions between life-saving (e.g. heart) and life-enhancing organ (e.g. kidney) transplants. We will suggest guidance and possible options for policy makers on listing children who are foreign nationals for transplantation.

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References

  1. Stevens D. Asylum seekers and the right to access health care. N Ir Legal Q. 2010;61(4):363–90.

    Google Scholar 

  2. Holtz M. Illegal immigrant gets kidney. Loyola covers costs of transplant. The Chicago Tribune. 9 Dec 2012;Sect. News.

    Google Scholar 

  3. Bernstein N. For illegal immigrant, line is drawn at transplant. New York Times. 2011 December 20;Sect. N.Y./Region.

    Google Scholar 

  4. Marsden S. NHS organs donated to foreign patients. The telegraph. 2013;Sect. Health News.

    Google Scholar 

  5. Miklavcic A. Canada’s non-status immigrants: negotiating access to health care and citizenship. Med Anthropol. 2011;30(5):496–517.

    Article  Google Scholar 

  6. Krogstad JM, Gonzalez-Barrera A, Lopez MH. Children 12 and under are fastest growing group of unaccompanied minors at U.S. border: pew research center; 2014 (updated July 22; cited 17 Sept 2014). Available from: http://www.pewresearch.org/fact-tank/2014/07/22/children-12-and-under-are-fastest-growing-group-of-unaccompanied-minors-at-u-s-border/.

  7. Ornstein C, Glionna JM. After livers, cash to UCLA. LA Times. 2008 May 31.

    Google Scholar 

  8. Schold JD, Meier-Kriesche H-U, Duncan PR, Reed AI. Deceased donor kidney and liver transplantation to nonresident aliens in the United States. Transplantation. 2007;84(12):1548–56.

    Article  Google Scholar 

  9. Gouvernement du Québec. Chapitre S-4.2 Loi sur les services de santé et les services sociaux 2013 [cited 2013 June 18]. Available from: http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=/S_4_2/S4_2.html.

  10. Bruni R, Wright L. Sharing organs with foreign nationals. Prog Transplant. 2011;21(1):78–82.

    Article  Google Scholar 

  11. ServiceOntario. Public HOSPITALS ACT R.S.O. 1990, CHAPTER P.40 1990 (updated 2010; cited 9 Sept 2013). Available from: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90p40_e.htm#BK20.

  12. Fortin M-C, Williams-Jones B. Should we perform kidney transplants on foreign nationals? J Med Ethics. 2014;40:821–6.

    Article  Google Scholar 

  13. Trillium Gift of Life Network. Organ transplantation for uninsured and non-residents. preliminary jurisdictional scan and review. In: Trillium gift of life network transplant ethics working group, editor; 2014.

    Google Scholar 

  14. Eurotransplant Foundation. Eurotransplant manual version 4.0. Leiden, The Netherlands: Eurotransplant Foundation; 2014.

    Google Scholar 

  15. Zuidema W, Tronchet N, Luchtenburg A, de Klerk M, IJzermans JNM, Weimar W. Nonresident living kidney donors. Transplant Proc. 2005;37:598–9.

    Article  Google Scholar 

  16. The Council of the European Union. Council Directive 2003/109/EC of 25 November 2003 concerning the status of third-country nationals who are long-term residents. Official J European Union. 2004;47(L16):44.

    Google Scholar 

  17. Eurotransplant Foundation. Eurotransplant manual version 3.2. Leiden, The Netherlands: Eurotransplant Foundation; 2013.

    Google Scholar 

  18. Buggins E. Allocation of organs to non UK EU residents: department of health, NHS blood and transplant; 2009. Available from: http://www.bts.org.uk/Documents/Publications/Buggins%20Report%20-%20ALLOCATION%20OF%20ORGANS%20TO%20NON%20UK%20EU%20RESIDENTS.pdf.

  19. NHS Blood and Transplant. Eligibility of non-UK residents to receive donated organs 2009 (cited 25 Sept 2014). Available from: http://www.organdonation.nhs.uk/newsroom/statements_and_stances/statements/non_uk_eligibility.asp.

  20. Zalewska K. Introduction to patient selection and organ allocation policies 2013 [cited 2015 January 7]. Available from: http://www.odt.nhs.uk/pdf/introduction_to_selection_and_allocation_policies.pdf.

  21. NHS Blood and Transplant. Guidance and policies 2014 (cited 17 Sept 2014). Available from: http://www.odt.nhs.uk/transplantation/guidance-policies/.

  22. Organ Procurement and Transplantation Network. Policy 6.0 deceased donor organ transplantation of non-US residents/non-US citizens, and the importation of deceased donor organs from foreign sources; 2013.

    Google Scholar 

  23. Organ Procurement and Transplantation Network. Proposed revisions to and reorganization of policy 6.0 (Transplantation of Non-Resident Aliens), which include changes to the non-resident alien transplant audit trigger policy and related definitions 2012 [cited 2013 January 9]. Available from: http://optn.transplant.hrsa.gov/PublicComment/pubcommentPropSub_290.pdf.

  24. Illinois General Assembly. Bill status of SB0741 2014 [cited 2015 January 5]. Available from: http://www.ilga.gov/legislation/BillStatus.asp?DocTypeID=SB&DocNum=741&GAID=12&SessionID=85&LegID=70138#top.

  25. Cantrelle C, Laurens C, Luciolli E, Loty B, Tuppin P. Access to kidney transplantation in France of non-French patients and French patients living in overseas territories. Transplantation. 2006;81(8):1147–52.

    Article  Google Scholar 

  26. Cantrelle C, Pessione F, Macher M-A, Thuong M. Évolution de l’accès à la greffe rénale en France des patients étrangers ou résidant outre-mer. Bulletin de la Société de Pathologie Exotique. 2012;105:115–22.

    Article  Google Scholar 

  27. Scandiatransplant. Guidelines for deceased organ transplantation of non-nordic nationals within Scandiatransplant and the use of non-nordic organs for Scandiatransplant recipients 2014. Available from: http://www.scandiatransplant.org/organ-allocation/GuidelinesnonNordicnationalsMay2014.PDF.

  28. Steering Committee of the Istanbul Summit. Organ trafficking and transplant tourism and commercialism: the declaration of Istanbul. Lancet. 2008;372(9632):5–6.

    Article  Google Scholar 

  29. The Transplantation Society of Australia and New Zealand. Organ transplantation from deceased donors: consensus statement on elibiligy cirteria and allocation protocols version 1.3. 2014.

    Google Scholar 

  30. Carella C, Cozzi E, Di Ciaccio P, Nanni Costa A. Transplantation of non-nationals and non-residents in the countries of the council of Europe: results of a survey conducted in the context of the initiatives of the European committee on organ transplantation. Newslett Transplant. 2012;17(1):83–7.

    Google Scholar 

  31. Canadian Institute for Health Information. Canadian organ replacement register annual report: treatment of end-stage organ failure in Canada, 2003 to 2012. Ottawa: CIHI; 2014.

    Google Scholar 

  32. Prottas JM, Jonasson O, Kleinig JI. In Organ transplants, American first? Hastings center report. 1986:23–5.

    Google Scholar 

  33. Cole P. Human rights and the national interest: migrants, healthcare and social justice. J Med Ethics. 2007;33:269–72.

    Article  Google Scholar 

  34. Glazier AK, Danovitch GM, Delmonico FL. Organ transplantation for nonresidents of the United States: a policy for transparency. Am J Transplant. 2014;14(8):1740–3.

    Article  Google Scholar 

  35. Flynn J, Shaul RZ, Hanson MD, Borschel GH, Zuker R. Pediatric facial transplantation: ethical considerations. Can J Plast Surg = Journal canadien de chirurgie plastique. 2014;22(2):67–9.

    Google Scholar 

  36. Simmerling M, Angelos P, Goldberg AM, Frader JE. Do gifts create moral obligations for recipients? Am J Bioeth. 2004;4(4):20–2.

    Article  Google Scholar 

  37. Bramstedt KA. Supporting organ transplantation in non-resident aliens within limits. Eth Med Christ Perspect Issues Bioeth. 2006;22(2):75–81.

    Google Scholar 

  38. Annas GJ. The prostitute, the playboy, and the poet: rationing schemes for organ transplantation. Am J Publ Health. 1985;75(2):187–9.

    Article  Google Scholar 

  39. Participants in the International Summit on Transplant Tourism and Organ Trafficking convened by The Transplantation Society and International Society of Nephrology. The declaration of Istanbul on organ trafficking and transplant tourism 2008 (cited 20 August 2008). Available from: http://www.sciencedirect.com/science/MiamiMultiMediaURL/B6T1B-4SWYBM2-5/B6T1B-4SWYBM2-5-1/4886/cad07b9aabfc1fbe9c50d5818806e7fc/mmc1.pdf.

  40. Raghavan R, Sheikh-Hamad D. Descriptive analysis of undocumented residents with ESRD in a public hospital system. Dialysis Transpl. 2011;40:78–81.

    Google Scholar 

  41. Chernin G, Go-Oz A, Shashar M, Schwartz D, Weinstein T. Care of undocumented-uninsured immigrants in a large urban dialysis unit. BMC Nephrol. 2012;13:112.

    Article  Google Scholar 

  42. Volk ML, Warren GJW, Anspach RR, Couper MP, Merion RM, Ubel PA. Foreigners traveling to the U.S. for transplantation may adversely affect organ donation: a national survey. Am J Transplant. 2010;10:1468–72.

    Article  Google Scholar 

  43. Linden EA, Cano J, Coritsidis GN. Kidney tranpslantation in undocumented immigrants with ESRD: a policy whose time has come? Am J Kidney Dis. 2012;60(3):354–9.

    Article  Google Scholar 

  44. Canadian Medical Association. CMA Code of Ethics 2004 (updated March 2012; cited 6 Sept 2013). Available from: http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf.

  45. Code de déontologie des médecins. Loi médicale 2013 (updated Sept 1; cited 6 Sept 2013). Available from: http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=3&file=/M_9/M9R17.HTM.

  46. American Medical Association. Opinion 9.12—Patient-Physician Relationship: Respect for Law and Human Rights 2007 (cited 7 Sept 2014). Available from: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion912.page.

  47. Friedman AL, Friedman EA. Illegal aliens are not entitled to federally funded organ transplants. Transplantation. 2007;83(1):21–3.

    Article  Google Scholar 

  48. Cendales LC, Rahmel A, Pruett TL. Allocation of vascularized composite allografts: what is it? Transplantation. 2012;93(11):1086–7.

    Article  Google Scholar 

  49. Goldberg AM, Simmerling M, Frader JE. Why nondocumented residents should have access to kidney transplantation: arguments for lifting the federal ban on reimbursement. Transplantation. 2007;83(1):17–20.

    Article  Google Scholar 

  50. Crafter SR, Bell L, Foster BJ. Balancing organ quality, HLA-matching, and waiting times: impact of a pediatric priority allocation policy for deceased donor kidneys in Quebec. Transplantation. 2007;83(11):1411–5.

    Article  Google Scholar 

  51. Baran D. Deceased donor kidney allocation in the US, Europe, Australia and New Zealand. Montréal: Canadian Council for Donation and Transplantation; 2006.

    Google Scholar 

  52. UNICEF. Convention on the rights of the child- frequently asked questions 2005 (cited 9 Sept 2014). Available from: http://www.unicef.org/crc/index_30229.html.

  53. United Nations General Assembly. Convention on the rights of the child. In: Office of the high commissioner for human rights, editor. 1989.

    Google Scholar 

  54. Feinberg J. A child’s right to an open future. In: Aiken W, LaFollette H, editors. Whose Child? Parental rights, parental authority and state power. Totowa, NJ: Littlefield, Adams, and Co; 1980. p. 124–53.

    Google Scholar 

  55. Moser JJ, Veale PM, McAllister DL, Archer DP. A systematic review and quantitative analysis of neurocognitive outcomes in children with four chronic illnesses. Pediatric Anesthesia. 2013;23:1083–96.

    Article  Google Scholar 

  56. Ross LF, Parker W, Veatch RM, Gentry SE, Thistlethwaite JR Jr. Equal Opportunity Supplemented by Fair Innings: equity and efficiency in allocating deceased donor kidneys. Am J Transplant. 2012;12(8):2115–24.

    Article  Google Scholar 

  57. Veatch RM. Transplantation ethics. Washington D.C.: Georgetown University Press; 2000. 427 p.

    Google Scholar 

  58. Daniels N. Just health: meeting health needs fairly. Cambridge: Cambridge University Press; 2008.

    Google Scholar 

  59. Rawls J. A Theory of Justice. Cambridge: Harvard University Press; 1999.

    Google Scholar 

  60. Nussbaum MC. Creating Capabilities. Cambridge: The Belknap Press of Harvard University Press; 2011 237 p.

    Book  Google Scholar 

  61. Dixon R, Nussbaum MC. Childrens’ rights and a capabilities approach: the question of special priority. Cornell Law Rev. 2012;97:549–94.

    Google Scholar 

  62. Stahl JE, Tramontano AC, Swan JS, Cohen BJ. Balancing urgency, age and quality of life in organ allocation decisions—what would you do? A survey. J Med Ethics. 2008;34:109–15.

    Article  Google Scholar 

  63. Geddes CC, Rodger SC, Smith C, Ganai A. Allocation of deceased donor kidney for tranpslantation: opinions of patients with CKD. Am J Kidney Dis. 2005;46(5):949–56.

    Article  Google Scholar 

  64. Tong A, Jan S, Wong G, Craig JC, Irving M, Chadban S, et al. Patient preferences for the allocation of deceased donor kidneys for transplantation: a mixed methods study. BMC Nephrol. 2012;13(18).

    Google Scholar 

  65. Axelrod DA, McCullough KP, Brewer ED, Becker BN, Segev DL, Raog PS. Kidney and pancreas transplantation in the United States, 1999–2008: the changing face of living donation. Am J Transplant. 2010;10(Part 2):987–1002.

    Google Scholar 

  66. Capitaine L, Van Assche K, Pennings G, Sterckx S. Pediatric priority in kidney allocation: challenging its acceptability. Transplant Int. 2014;27(6):533–40.

    Article  Google Scholar 

  67. Andreoni K, Forbes R, Andreoni R, Phillips G, Stewart H, Ferris M. Age-related kidney transplant outcomes: health disparities amplified in adolescence. JAMA Int Med. 2013;173(16):1524–32.

    Article  Google Scholar 

  68. Pape L, Ehrich JH, Zivicnjak M, Offner G. Growth in children after kidney transplantation with living related donor graft or cadaveric graft. Lancet. 2005;366(9480):151–3.

    Article  Google Scholar 

  69. Qvist E, Pihko H, Fagerudd P, Valanne L, Lamminranta S, Karikoski J, et al. Neurodevelopmental outcome in high-risk patients after renal transplantation in early childhood. Pediatr Transplant. 2002;6(1):53–62.

    Article  Google Scholar 

  70. Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11(10):2093–109.

    Article  Google Scholar 

  71. Manns BJ, Mendelssohn DC, Taub KJ. The economics of end-stage renal disease care in Canada: incentives and impact on delivery of care in Canada. Int J Health Care Finance Econ. 2007;7:149–69.

    Article  Google Scholar 

  72. McDonald SP, Craig JC. Long-term survival of children with end-stage renal disease. New Engl J Med. 2004;350(26):2654–62.

    Article  Google Scholar 

  73. The Children Hospital of Philadelphia. World’s first bilateral hand transplant on a child performed at the children’s hospital of Philadelphia 2015 (cited 15 Sept 2015). Available from: http://www.chop.edu/news/world-s-first-bilateral-hand-transplant-child-performed-children-s-hospital-philadelphia#.Vfhpun2CTIl.

  74. Stoddard FJ, Norman DK, Murphy JM. A diagnostic outcome study of children and adolescents with severe burns. J Trauma. 1989;29(4):471–7.

    Article  Google Scholar 

  75. Rosenberg L, Robert R, Thomas C, Holzer CE 3rd, Blakeney P, Meyer WJ 3rd. Assessing potential suicide risk of young adults burned as children. J Burn Care Res Official Publ Am Burn Assoc. 2006;27(6):779–85.

    Article  Google Scholar 

  76. Sheridan RL, Hinson MI, Liang MH, Nackel AF, Schoenfeld DA, Ryan CM, et al. Long-term outcome of children surviving massive burns. JAMA. 2000;283(1):69–73.

    Article  Google Scholar 

  77. Kaufman SS, Atkinson JB, Bianchi A, Goulet OJ, Grant D, Langnas AN, et al. Indications for pediatric intestinal transplantation: a position paper of the American Society of Transplantation. Pediatr Transplant. 2001;5(2):80–7.

    Article  Google Scholar 

  78. Mazariegos GV, Steffick DE, Horslen S, Farmer D, Fryer J, Grant D, et al. Intestine transplantation in the United States, 1999–2008. Am J Transplant Official J Am Soc Transplant Am Soc Transplant Surg. 2010;10(4 Pt 2):1020–34.

    Article  Google Scholar 

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Authors and Affiliations

  1. Centre de recherche du CHUM, Nephrology and Transplant Division Centre hospitalier de l’Université de Montréal, Montreal, Canada

    Marie-Chantal Fortin

  2. Bioethics Department, The Hospital for Sick Children, Toronto, Canada

    Rebecca A. Greenberg

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  1. Marie-Chantal Fortin
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  2. Rebecca A. Greenberg
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Correspondence to Marie-Chantal Fortin .

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Editors and Affiliations

  1. Department of Family and, The Hospital for Sick Children, Toronto, Canada

    Rebecca A. Greenberg

  2. Dept. of Pediatrics, Winnipeg Regional Health Authority, Winnipeg, Canada

    Aviva M. Goldberg

  3. Department of Philosophy I, University of Granada, Madrid, Spain

    David Rodríguez-Arias

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Fortin, MC., Greenberg, R.A. (2016). Should Transplantation Be Offered to Pediatric Foreign Nationals?. In: Greenberg, R., Goldberg, A., Rodríguez-Arias, D. (eds) Ethical Issues in Pediatric Organ Transplantation. International Library of Ethics, Law, and the New Medicine, vol 66. Springer, Cham. https://doi.org/10.1007/978-3-319-29185-7_13

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