Factors Related to International Travel for Transplantation Among U.S.-Listed Kidney Transplant Candidates.
Brittany Koons, Helene Moriarty, Tamara M Kear and 2 others
PMID 31490049WHAT IT FOUND
US kidney candidates who traveled abroad for transplant were more often younger, male, Asian, college-educated, privately insured, employed, or non-US citizens/residents.
Nurses in pre-transplant care can ask about these plans and discuss risks and coverage.
Key findings
01Candidates removed from the US wait list for transplant abroad were more often Asian (55.8% vs 6.8% in the US), male (70.1% vs 60.4%), age 18 to 34 (19.0% vs 13.2%), college educated (72.6% vs 48.8%), privately insured (68.9% vs 39.9%), and non-US citizens/non-US residents (10.2% vs 0.9%).
02In adjusted models, Asian candidates had 11.58-fold higher odds of traveling abroad than white candidates, and non-US citizens/non-US residents had 11.40-fold higher odds than US citizens/residents.
03Travel abroad was less likely with older age, BMI greater than 30, dialysis for 2 to 6 years or longer, and cPRA 80 to 94 or 95 to 100.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only candidates already on the US waiting list who were removed for transplant abroad or US deceased donor transplant were included, so people who traveled without ever being listed were missed. Most data were collected at listing and uploaded to the registry, and the study could not confirm whether employment or insurance details were updated before removal. The registry did not include family or social support information, so these possible influences could not be examined. Only 364 candidates traveled abroad compared with 76,133 US transplants, so the study shows associations, not causes, and cannot predict individual patient choices. Missing covariates were imputed under an assumption that missingness was random. The study did not measure why candidates traveled or what happened after transplant abroad.
The easy way to misread this
Do not treat these factors as a prediction that a patient will travel or as proof that a factor causes travel. The study compared national registry records of candidates removed from the US list for transplant abroad or US transplant, and it did not measure patients' reasons, plans, or post-transplant outcomes.