A Hawaii News Now report said that nearly half of the kidneys donated in Hawaiʻi go to recipients on the continent. But the primary kidney transplant surgeon at The Queen's Medical Center on Oʻahu aid that’s only half the story.
"What they did not say in detail is exactly the reason why that is, and it's not that we're basically giving organs to the mainland. That's not the case," said Dr. Lung-Yi "Felix" Lee of The Queen's Health Systems.
Transplant operations and waitlists nationwide are coordinated by the United Network for Organ Sharing, commonly known as UNOS.
"The UNOS system prioritizes local recipients because they want the organ to stay locally," Lee said. However, he said exceptions arise when patients have been waiting for a long time or have extremely specific antibodies — and sometimes an organ doesn't have a match in Hawaiʻi.
"We cannot think of Hawaiʻi versus the continental U.S. as one-to-one," he said. "We are actually doing very well in keeping the organs here within our area."
Lee said there’s a bigger transplant crisis not talked about enough. He is a co-author on a new study drawing attention to the low number of solid organ transplants in the U.S. Pacific Island territories.
Despite residents having higher rates of kidney failure than those in the continental U.S., the study found that 48 patients residing in the U.S. Pacific territories underwent liver and kidney transplants over a 21-year period.
Lee and his co-author, Dylan Bush, presented the results at the World Transplant Congress in San Francisco earlier this month.
"Additionally, of course, there's no transplant centers or organ procurement organizations in the U.S. Pacific Island territories. That means that patients have to relocate, often thousands of miles, for care," Bush said.
He said that about 1 out of every 1,000 patients living in the U.S. Pacific Island territories who needed a kidney actually received a kidney in 2021, whereas 300 out of every 1,000 waitlisted patients were transplanted in the 50 states.
As a practicing doctor in Hawaiʻi, Lee said he was shocked. He thought the number would be higher.
"Yet, when I went to the database, they are not documented as such, because by getting on the transplant list, they basically have to move here to Hawaiʻi. So now they are recorded as a Hawaiʻi resident, so their numbers, for me, got skewed," Lee said.
Bush said he hopes the study encourages those in the medical field and in government to think about how to improve transplant access, such as through telehealth, collaborations with local providers, and more awareness of the need for organ donor registrations.
Back in Hawaiʻi, Lee said that since the Hawaii News Now story, some people have questioned why they should register as organ donors.
"Ultimately, it's the patients here that get hurt if we don't have new donors. So we need to increase the number of people who are willing to donate, so we have enough good organs that we can actually benefit the people here in Hawaiʻi," he added.
This story aired on The Conversation on Aug. 19, 2025. The Conversation airs weekdays at 11 a.m. Sophia McCullough and Hannah Kaʻiulani Coburn adapted this story for the web.
