Dear Transplant Program Directors,
The Organ Procurement and Transplantation Network (OPTN), in collaboration with the Health Resources and Services Administration (HRSA), is issuing this message to remind Transplant Programs about the OPTN policy regarding the transplantation of non-U.S. residents and non-U.S. citizens.
Media reporting has raised concern about practices that may resemble or be perceived as “transplant tourism,” including arrangements that could undermine equitable organ allocation, transparency, and compliance with OPTN Policy 17: International Organ Transplantation. The OPTN Board takes these concerns seriously and active review is underway. Additionally, the OPTN has convened a workgroup to review the current International Organ Transplantation Policy and assess whether additional safeguards, clarification, or oversight mechanisms are warranted.
The integrity of the U.S. organ donation and transplantation system depends on equitable organ allocation based on sound medical judgment, strict adherence to OPTN policy, and maintaining public trust in the system. To reinforce these principles, we remind all transplant programs of the following OPTN policy requirements:
Contracts or Structured Arrangements with Foreign Governments or Entities Are Prohibited
The OPTN International Organ Transplantation Policy states: “Members may not enter into contracts with foreign agencies or governments for the transplant of non-U.S. residents/non-U.S. citizens. Members may negotiate the terms and conditions under which any individual candidate would be treated with the understanding that each candidate must be referred on a case-by-case and physician-to-physician basis.”
Each candidate must be evaluated individually. Decisions to list non-U.S. residents/non-U.S. citizens must be based solely on clinical criteria and in compliance with OPTN policies. Agreements with foreign governments, agencies, or third parties acting on behalf of a foreign entity violate the OPTN policy. Financial arrangements, referral pathways, or other external pressures must not influence organ allocation or create preferential access. See also OPTN Policy 5.4.A: Non-Discrimination in Organ Allocation (“A candidate’s citizenship or residency status in the United States must not be considered when allocating deceased donor organs to candidates for transplantation. Allocation of deceased donor organs must not be influenced positively or negatively by political influence, national origin, ethnicity, race, sex, religion, or financial status”).
Allocation Must Follow OPTN Policy
All transplants, including those involving non-U.S. residents/non-U.S. citizens, must strictly follow OPTN allocation policies. Any urgent-status patient registrations on OPTN transplant waitlists are subject to peer review. Review board decisions must be fair and based entirely on clinical information that complies with OPTN policies.
The OPTN and HRSA remain committed to safeguarding an equitable and transparent donation and transplantation system that prioritizes medical urgency and equity. We appreciate the diligence and professionalism of all OPTN members in advancing lifesaving organ donation, procurement, and transplantation.
Thank you for your cooperation and continued dedication to safe, reliable organ transplantation, donation and procurement practice.
Sincerely,
John C. Magee, MD
President, OPTN Board of Directors