Greenberg Rebecca, Ballesteros-Gallego Fabián, Allard Julie, Fortin Marie-Chantal
Department of Bioethics, Mount Sinai Hospital, Toronto, ON, Canada.
Department of Paediatrics, Faculty of Medicine, University of Toronto, ON, Canada.
Can J Kidney Health Dis. 2019 Jul 2;6:2054358119859530. doi: 10.1177/2054358119859530. eCollection 2019.
Transplantation for foreign nationals (non-citizens and non-residents) (FNs) in Canada is a complex issue. Currently, there are no Canadian guidelines for the provision of organ transplantation for FNs, and no empirical data on this issue or on transplant professionals' practices are available.
This project aimed to gather empirical data on transplant professionals' perspectives and practices regarding transplantation for FNs.
Survey research design.
A Web-based survey of members of the Canadian Society of Transplantation (CST).
All members of the CST were invited to participate between April and June 2016.
Multiple-choice questions were developed to capture participants' attitudes toward different fictitious clinical scenarios in which an FN needed a transplant, their experiences with FNs, their attitude toward FNs in need of transplantation, their knowledge about relevant institutional and organ donation organization (ODO) policies, and their perspectives on a quota. There were two questions with a five-point Likert scale to measure respondents' agreement with statements related to possible policy options and arguments for and against transplantation for FNs. There was one open-ended question about the content of transplant programs' policies on transplantation for FNs.
Descriptive statistical analysis were performed.
A total of 87 transplant professionals completed the survey. Over the 4-year period from 2012 to 2016, 47.1% of respondents dealt with at least one situation of listing or performing a transplant for an FN. Only 19.5% of respondents reported that their transplant program had a policy about transplantation for FNs and 59.7% did not know if their ODO had such a policy. When asked about policy options, 47.5% disagreed with a policy of no transplantation for FNs and 41.4% agreed with offering transplantation for FNs in some circumstances (including life-saving and non-life-saving organs). Study participants agreed that transplantation should not be offered to FNs traveling to Canada specifically for transplantation, that FNs should not be transplanted with organs not suitable for Canadian citizens and that there should not be a transplantation quota for FNs. Participants also seem to be more inclined to offer transplantation of life-saving organs, particularly for children.
The major limitation of this study is the low response rate of transplant professionals to this survey.
This is the first study to describe Canadian transplant professionals' perspectives on transplantation for FNs. The findings of this study will be of interest for future policy development on access to transplantation for FNs. Further studies are needed to gather various key stakeholders' perspectives on this issue, as well as to analyze the legal and ethical issues and the economics, to develop future policies.
在加拿大，为外国公民（非公民及非居民）进行器官移植是一个复杂的问题。目前，加拿大没有针对外国公民器官移植的指导方针，也没有关于此问题或移植专业人员实践的实证数据。
本项目旨在收集关于移植专业人员对外国公民器官移植的观点和实践的实证数据。
调查研究设计。
对加拿大移植学会（CST）成员进行基于网络的调查。
邀请CST的所有成员在2016年4月至6月期间参与。
设计了多项选择题，以了解参与者对不同虚构临床场景的态度，在这些场景中外国公民需要进行移植，他们与外国公民的经历，他们对需要移植的外国公民的态度，他们对相关机构和器官捐赠组织（ODO）政策的了解，以及他们对配额的看法。有两个采用五点李克特量表的问题，用于衡量受访者对与可能的政策选择以及支持和反对为外国公民进行移植的论据相关陈述的认同程度。有一个开放式问题，询问移植项目关于外国公民移植的政策内容。
进行描述性统计分析。
共有87名移植专业人员完成了调查。在2012年至2016年的4年期间，47.1%的受访者至少处理过一例为外国公民列出移植名单或进行移植的情况。只有19.5%的受访者表示他们的移植项目有关于外国公民移植的政策，59.7%的人不知道他们的器官捐赠组织是否有这样的政策。当被问及政策选择时，47.5%的人不同意不为外国公民进行移植的政策，41.4%的人同意在某些情况下（包括挽救生命和非挽救生命的器官）为外国公民提供移植。研究参与者一致认为，不应为专门前往加拿大进行移植的外国公民提供移植，外国公民不应接受不适合加拿大公民的器官移植，并且不应为外国公民设定移植配额。参与者似乎也更倾向于提供挽救生命器官的移植，特别是为儿童。
本研究的主要局限性是移植专业人员对该调查的低回复率。
这是第一项描述加拿大移植专业人员对外国公民器官移植观点的研究。本研究的结果将对未来关于外国公民器官移植准入政策的制定具有参考价值。需要进一步研究以收集各关键利益相关者对该问题的观点，以及分析法律和伦理问题及经济学问题，以制定未来政策。
