Crossing National Borders for Transplantation: A Focused Evaluation of Deceased Donor Lung Exports from the United States

Organ transplantation is a life-saving treatment for end-stage organ failure patients, but the 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 national SRTR data from January 2014-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<0.001), more likely Hepatitis-C positive(22% vs. 4%,p<0.001), and more likely donors after circulatory death(20% vs 7%,p<0.001). Lungs that were eventually exported were offered to more US PTRs (median=65) than those kept in the US(median=21 and 41 for lungs recovered by non-exporting and exporting OPOs;p<0.001). 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.