*Purpose: Transplant tourism is a phenomenon where patients travel away from their home to receive organ transplantation where organs are more readily available. This flow of patients and organs raises questions regarding the equitable distribution of the life-saving organs. Though foreign travel by U.S. citizens in search of transplantation is rare, it is common for these same patients to travel domestically to be listed at centers with shorter waitlist times. This study analyzes the patients at a single, high volume liver transplant center to determine the characteristics of these domestic transplant tourists, and if they are advantaged by traveling for transplant.

*Methods: The transplant research database at a single, large center in the Midwestern U.S. was analyzed for patients undergoing liver transplant between 2001 and 2019. There were three study groups: local in-state residents, patients from adjacent states, and those from distant states. Besides the medical history, the complete psycho-social summary for each patient was reviewed and included data such as income, education, employment status and social support. Outcomes included time to liver transplant and long term survival.

*Results: There were 2320 patients transplanted during the study period, and 431 were out-of-state residents (19%). There were 81% local in-state residents, 9% from an adjacent state, and 10% from a distant state. Patients from out-of-state were more likely to have HCV and HCC. The median waitlist time to transplant for these three groups was 43, 38 and 29 days (p<0.001). Donor organs for the out-of-state residents were significantly younger (p<0.01), but were otherwise similar. Graft survival is shown in the Figure and favors the out-of-state residents over the local in-state residents. Out-of-state residents have higher education levels and higher income compared to local in-state residents.

*Conclusions: U.S. citizens who travel domestically to receive a transplant appear to be advantaged by a short wait time to transplant, younger donors and better long term survival. These findings raise the question of transplant equity within the U.S. and inform the discussion regarding organ distribution.

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