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Stock PG, Nagral S, Rondeau E, Gawronska S, Groverman J, Barbari A, Coates PT, Domínguez-Gil B, Fadhil R, Malyszko J, Niño Murcia A. Transplantation in the Context of Migration and Refugees: A Summary of the DICG and TTS Ethics Committee Workshop, Buenos Aires, Argentina, September 2022. Transplantation 2024:00007890-990000000-00667. [PMID: 38383953 DOI: 10.1097/tp.0000000000004918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Global conflicts and humanitarian crises have resulted in an unprecedented number of refugees and migrants. This challenges the limited resources of health care systems and jeopardizes the availability of transplant care for these deserving migrants and refugees. This was the basis for a workshop held during the Congress of the Transplantation Society (Buenos Aires, 2022). We elaborate on the proceedings of the workshop entitled "Transplantation in the Context of Migration and Refugees," organized by the Ethics Committee of The Transplantation Society and Declaration of Istanbul Custodian Group. Transplant providers from around the world shared strategies of how each region has responded to providing access to care for refugees and migrants in need of transplant services. The potential exploitation of this vulnerable group leading to illicit organ removal was addressed for each region. The Transplantation Society, Declaration of Istanbul Custodian Group, and global transplant community should continue to focus on the status of refugees and migrants and collaborate on strategies to provide access to transplant care for this deserving population. Global cooperation will be essential to provide vigilant oversight to prevent exploitation of this vulnerable population.
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Affiliation(s)
- Peter G Stock
- Department of Transplant Surgery, University of California San Francisco, San Francisco, CA
- Ethics Committee of The Transplantation Society, Montreal, QC, Canada
| | - Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
- Declaration of Istanbul Custodian Group (DICG), Montreal, QC, Canada
| | - Eric Rondeau
- Declaration of Istanbul Custodian Group (DICG), Montreal, QC, Canada
- Soins intensifs nephrologiques et Rein aigu, hôpital Tenon, Paris, France
| | - Sylwia Gawronska
- United Nations Office on Drugs and Crime (UNODC), Regional Office for Southeast Asia and the Pacific (ROSEAP), Bangkok, Thailand
| | | | - Antoine Barbari
- Department of Nephrology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - P Toby Coates
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Faculty of Health and Medical Sciences, University of Adelaide, SA, Australia
| | - Beatriz Domínguez-Gil
- Ethics Committee of The Transplantation Society, Montreal, QC, Canada
- Organización Nacional de Trasplantes, Madrid, Spain
| | - Riadh Fadhil
- Ethics Committee of The Transplantation Society, Montreal, QC, Canada
- Qatar Organ Donation Centre, Hamad Medical Corporation, Doha, Qatar
| | - Jolanta Malyszko
- Declaration of Istanbul Custodian Group (DICG), Montreal, QC, Canada
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Alejandro Niño Murcia
- Ethics Committee of The Transplantation Society, Montreal, QC, Canada
- Department of Transplantation Surgery, Colombiana de Trasplantes, Bogotá, Colombia
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van Overdijk PAH, Grossi AA, van Delft CH, Jansen NE, van den Hoogen MWF, Paredes-Zapata D. Disparities in kidney transplantation accessibility among immigrant populations in Europe: A systematic review and meta-analysis. Transplant Rev (Orlando) 2024; 38:100814. [PMID: 38065001 DOI: 10.1016/j.trre.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/25/2023] [Accepted: 11/26/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Disparities in access to healthcare for patients with an immigration background are well-known. The aim of this study was to determine whether disparities among immigrant populations translate into a relative difference in the number of kidney transplants (KT) performed in documented immigrant patients (first and second generation) relative to native-born patients in Europe. METHODS A literature search was performed in PubMed from inception to 11-10-2022. Studies were eligible if: (1) written in English, (2) included immigrant and native-born KT patients, (3) performed in countries registered as Council of Europe members, (4) focused on documented first- and second-generation immigrant populations [1]. Systematic reviews, literature reviews, and case reports or articles about emigration, non-KT, and undocumented immigrants were excluded. The outcome measurement was a relative percentage of KTs to the total population per 100.000 residents. By dividing the immigrant percentages by the native-born resident percentages, the odds ratio (OR) was calculated in a meta-analysis. The risk of bias was assessed; articles with high risk of bias were excluded in a second meta-analysis. RESULTS Out of 109 articles, 5 were included (n = 24,614). One Italian study (n = 24,174) had a ratio below 1, being 0.910 (95%CI 0.877-0.945). The other four articles (n = 196, n = 283, n = 77, n = 119) had ratios above 1: 1.36 (95%CI 0.980-1.87), 2.04 (95%CI 1.56-2.68), 2.23 (95%CI 1.53-3.25) and 2.64 (95%CI 1.68-4.15). After performing a meta-analysis, the OR did not show a significant difference: 1.68 (95%CI 1.03-2.75). After bias correction, this remained unchanged: 1.78 (95%CI 0.961-3.31). CONCLUSIONS In our meta-analysis we did not find a significant difference in the relative number of KTs performed in immigrant versus native-born populations in Europe. However, a lesser likelihood for immigrants to receive a pre-emptive kidney transplantation was found. Large heterogeneity between studies (e.g. different sample size, patient origins, study duration, adult vs children patients) was a shortcoming to our analysis. Nevertheless, our article is the first review in this understudied topic. As important questions (e.g. on ethnicity, living donor rate) remain, future studies are needed to address them.
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Affiliation(s)
- Pieter A H van Overdijk
- Bachelor Student Technical Medicine, Erasmus MC, PO Box 2040, Rotterdam 3000 CA, the Netherlands.
| | - Alessandra A Grossi
- Department of Human Sciences, Innovations and Territory, University of Insubria, Via O. Rossi 9, Varese 21100, Italy; Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Via O. Rossi 9, 21100 Varese, Italy
| | - Céline H van Delft
- Bachelor Student in Medicine, Erasmus MC, PO Box 2040, Rotterdam 3000 CA, the Netherlands
| | - Nichon E Jansen
- Senior Policy Advisor, Senior Researcher, Dutch Transplant Foundation, Postbus 2304, Leiden 2301 CH, the Netherlands
| | - Martijn W F van den Hoogen
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center Rotterdam, PO BOX 2040, Rotterdam 3000 CA, the Netherlands
| | - David Paredes-Zapata
- Consultant, Nephrologist, Donation and Transplant Coordination Section, Hospital Clinic, Associate Professor University of Barcelona, Surgical Department, C. de Villarroel, Barcelona 170 08036, Spain
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Sever MS, Vanholder R, Luyckx V, Eckardt KU, Kolesnyk M, Wiecek A, Pawlowicz-Szlarska E, Gallego D, Shroff R, Škoberne A, Nistor I, Sekkarie M, Ivanov D, Noruišiene E, Tuglular S. Armed conflicts and kidney patients: a consensus statement from the Renal Disaster Relief Task Force of the ERA. Nephrol Dial Transplant 2023; 38:56-65. [PMID: 35998320 DOI: 10.1093/ndt/gfac247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Indexed: 01/26/2023] Open
Abstract
During conflicts, people with kidney disease, either those remaining in the affected zones or those who are displaced, may be exposed to additional threats because of medical and logistical challenges. Acute kidney injury developing on the battlefield, in field hospitals or in higher-level hospital settings is characterized by poor outcomes. People with chronic kidney disease may experience treatment interruptions, contributing to worsening kidney function. Patients living on dialysis or with a functioning graft may experience limitations of dialysis possibilities or availability of immunosuppressive medications, increasing the risk of severe complications including death. When patients must flee, these threats are compounded by unhealthy and insecure conditions both during displacement and/or at their destination. Measures to attenuate these risks may only be partially effective. Local preparedness for overall and medical/kidney-related disaster response is essential. Due to limitations in supply, adjustments in dialysis frequency or dose, switching between hemodialysis and peritoneal dialysis and changes in immunosuppressive regimens may be required. Telemedicine (if possible) may be useful to support inexperienced local physicians in managing medical and logistical challenges. Limited treatment possibilities during warfare may necessitate referral of patients to distant higher-level hospitals, once urgent care has been initiated. Preparation for disasters should occur ahead of time. Inclusion of disaster nephrology in medical and nursing curricula and training of patients, families and others on self-care and medical practice in austere settings may enhance awareness and preparedness, support best practices adapted to the demanding circumstances and prepare non-professionals to lend support.
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Affiliation(s)
- Mehmet S Sever
- Istanbul University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium; Nephrology Section, Department of Internal Medicine and, Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valerie Luyckx
- Department of Nephrology, University Children's Hospital, Zurich, Switzerland; Department of Paediatrics and Child, Health, University of Cape Town, Cape Town, South Africa; Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mykola Kolesnyk
- SI Institute of Nephrology of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Ewa Pawlowicz-Szlarska
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland
| | - Daniel Gallego
- European Kidney Health Alliance, Brussels, Belgium; European Kidney Patient Federation, Wien, Austria
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Andrej Škoberne
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Ionut Nistor
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania; Department of Nephrology, Dr C I Parhon University Hospital, Iasi, Romania
| | | | - Dmytro Ivanov
- Department of Nephrology and RRT Shupyk, National Health Care University, Kyiv, Ukraine
| | - Edita Noruišiene
- European Kidney Health Alliance, Brussels, Belgium; European Dialysis and Transplant Nurses Association - European Renal Care Association
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
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Martin DE, Fadhil RAS, Więcek A. Ethical Aspects of Kidney Donation and Transplantation for Migrants. Semin Nephrol 2022; 42:151271. [PMID: 36577643 DOI: 10.1016/j.semnephrol.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Migrants represent a large and diverse population globally that includes international refugees, stateless persons, expatriate workers, and more. Many migrants face significant barriers in accessing health care, especially scarce and costly resources such as dialysis and kidney transplantation. Improving equity of access to these kidney replacement therapies for migrant populations may present a range of complex ethical dilemmas, particularly in the setting of crises and when considering the use of residency status and citizenship as eligibility criteria for access to treatment. In this article, we discuss ethical obligations to provide kidney care for migrants, the implications of the self-sufficiency concept with regard to access to deceased donation and transplantation, factors that may influence evaluation of the risks and benefits of transplantation for migrants with insecure access to care, and the vulnerability of migrants to organ trafficking. We also present a set of general recommendations to assist in preventing and managing ethical dilemmas when making decisions about policy or practice regarding kidney care for migrants.
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Affiliation(s)
| | - Riadh A S Fadhil
- Qatar Organ Donation Center, Hamad Medical Corporation, Doha, Qatar; Weill Cornell College of Medicine - Doha, Qatar
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
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López-Fraga M, Pérez-Blanco A, Domínguez-Gil B. International Travel for Transplantation: Time for Transparency. Transplantation 2022; 106:e112-e113. [PMID: 34608104 DOI: 10.1097/tp.0000000000003971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marta López-Fraga
- Directorate for the Quality of Medicines (EDQM), Council of Europe, Strasbourg, France
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