Organ transplantation is a life-saving treatment for end-stage organ failure patients, but the United States (US) faces a shortage of available organs. US policies incentivize identifying recipients for all recovered organs. Technological advancements have extended donor organ viability, creating new opportunities for long-distance transport and international sharing. We aimed to assess organ exports from deceased US donors to candidates abroad, a component of allocation policy allowed without suitable domestic candidates. Based on the national Scientific Registry of Transplant Recipients data from January 2014 to September 2023, 388 342 organs were recovered for transplantation, with 511 (0.13%) exported. Most exported organs were lungs (80%). Exported lung donors were older (41 vs 34 years, P < .001), more likely hepatitis C positive (22% vs 4%, P < .001), and more likely donors after circulatory death (20% vs 7%, P < .001). Lungs that were eventually exported were offered to more US potential transplant recipients (median = 65) than those kept in the US (median = 21 and 41 for lungs recovered by nonexporting and exporting organ procurement organizations, respectively; P < .001). Our study highlights the necessity for further research and clear policy initiatives to balance the benefits of cross-border sharing while considering potential opportunities for more aggressive organ allocation within the US.

中文翻译：

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跨国移植：对美国死者供肺出口的重点评估


器官移植是终末期器官衰竭患者的挽救生命的治疗方法，但美国面临可用器官短缺的问题。美国政策鼓励确定所有回收器官的接受者。技术进步延长了捐赠器官的活力，为长途运输和国际共享创造了新的机会。我们的目的是评估已故美国捐赠者向国外候选人的器官出口，这是在没有合适的国内候选人的情况下允许的分配政策的一部分。根据2014年1月至2023年9月国家移植受者科学登记数据，共回收了388 342个器官用于移植，其中511个（0.13%）被出口。大多数输出​​器官是肺（80%）。输出的肺捐献者年龄较大（41 岁 vs 34 岁，P < .001），丙型肝炎阳性的可能性更大（22% vs 4%，P < .001），循环死亡后的捐献者更有可能（20% vs 7%） ，P < .001)。最终出口的肺被提供给更多的美国潜在移植接受者（中位数 = 65），而不是保存在美国的肺（非出口和出口器官采购组织回收的肺的中位数分别 = 21 和 41；P < .001）。我们的研究强调了进一步研究和明确政策举措的必要性，以平衡跨境共享的好处，同时考虑美国境内更积极的器官分配的潜在机会。