Citizenship Status and Deceased Organ Donation in the USA

Noncitizens, especially those with undocumented immigration status, have major barriers to solid organ transplantation though they donate organs in the United States (US). However, the quality and use of organs donated by noncitizens has not been described. The aim of this study was to elucidate the characteristics of organs donated by noncitizens in the US.

In this cross-sectional study, we used Organ Procurement and Transplantation Network (OPTN) data examining US deceased organ donors (≥ 1 organ transplanted) between January 1, 2015 and December 31, 2020, stratified by reported citizenship status. To assess differences between groups, analysis of variance (normally distributed) or Kruskal-Wallis (nonnormally distributed) tests were used for continuous variables after testing for normality via the Shapiro-Wilk test and chi-square tests were used for categorical variables. The Benjamini-Hochberg procedure was used to adjust for multiple comparisons.

Noncitizens accounted for 3.1% of the donor population from 2015 to 2020. Compared with US citizens, noncitizens were older with higher proportions of male sex and O blood type (P < .001, for all). By state, New Jersey (9.5%), Texas (6.7%), and New York (6.1%) had the highest number of noncitizen residents who were organ donors by. Deceased noncitizen donors had a much lower rate of consent for donation compared with US citizens.

Our study demonstrates that noncitizens are donating healthy, viable organs to the US donor pool that are largely being received by US citizens. Given that noncitizens are donating organs to US, policy initiatives are needed to improve equity in access to transplantation receipt for this population.