title: Should we perform kidney transplants on foreign nationals?
abstract: In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians' duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them.
authors.affiliation: Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal, Montreal (CHUM), Canada Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Canada.
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Fortin
authors.affiliation: Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Canada.
authors.forename: Bryn
authors.initials: B
authors.lastname: Williams-Jones
mesh_terms: D002170:Canada; D054242:Emigrants and Immigrants / Q000331:legislation & jurisprudence; D005249:Fees and Charges / Q000941:ethics*; D005602:France; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics*; D006291:Health Policy; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D038622:Internationality; D016030:Kidney Transplantation / Q000191:economics / Q000941:ethics*; D018579:Patient Selection / Q000941:ethics*; D012036:Refugees; D009927:Tissue and Organ Procurement / Q000191:economics / Q000941:ethics*; D006113:United Kingdom; D014481:United States; D014850:Waiting Lists
keywords: Clinical Ethics; Distributive Justice; Donation/Procurement of Organs/Tissues; Foreign Nationals; Transplantation