108.2: International travel for organ transplantation by children: A survey of global activity (1 Jan 2023-31 Aug 2024).

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Introduction: International travel for organ transplantation (ITOT) is widespread; the Global Observatory on Donation and Transplantation-World Health Organization (WHO) data show at least 747 patients travelled from 35 countries for transplantation abroad in 2023.(1) Except for rare institutional case series reports, little is known about paediatric involvement in ITOT. We report here on paediatric-specific results from the 2024 ITOT Survey to provide a snapshot of current activity. Methods: An international anonymous survey of transplant professionals was conducted online (16 Sep-15 Dec 2024). The questionnaire (available in English, French, Mandarin and Spanish) assessed respondents’ most recent experiences (between 1 Jan 2023 and 31 Aug 2024 inclusive) of each of four potential case types: provision of care to an incoming or outgoing living donor (LD) or transplant recipient. Considering their most recent experience of each type, respondents were asked if the recipients involved were aged <18 years at the time of transplantation. Data were analysed with descriptive statistics. Results: 353 individuals from 64 countries completed the survey. 309 were clinically active between 1 Jan 2023 and 31 Aug 2024, of whom 166 (54%) had provided care for ≥1 incoming or outgoing LD or transplant recipient. Of the recipients most recently cared for by respondents, 23% (n=38) were children who travelled from 27 countries to 16 different countries for transplantation. All WHO regions were impacted by ITOT involving children. 50% of paediatric ITOT recipients received LD transplants, most (95%) from genetic relatives; 40% received deceased donor transplants; 10% unsure/undisclosed. 45% (n=17) received livers (32% kidneys; 13% heart; 8% combined kidney-liver; 3% undisclosed). 47% of paediatric transplants took place in the public sector (40% private; 5% other; 7% unsure/undisclosed). Considering respondents’ most recent experiences of care for LDs, 15% of LDs (n=14) had travelled to donate to a recipient aged <18 years. Conclusion: Children comprise nearly a quarter of the growing number of patients traveling internationally for transplantation. While ITOT may help to address barriers to transplant for children in many countries, it may also present clinical and ethical risks for this vulnerable population. Further research is needed to evaluate the factors influencing paediatric ITOT as well as the impact of ITOT on paediatric populations in destination countries and those from which children travel. Specific guidance may be needed to support policy-making that promotes equity of access and quality of paediatric transplant care in the cross-border setting. 1. GODT (Global Observatory on Donation and Transplantation). 2025. Organ Donation and Transplantation Activities 2023 Report. Available at:https://www.transplant-observatory.org/wp-content/uploads/2025/02/2023-data-global-report-20022025.pdf

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