A scoping review of inequities in access to organ transplant in the United States
Abstract Background Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-02-01
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| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12939-021-01616-x |
| _version_ | 1818973767551942656 |
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| author | Christine Park Mandisa-Maia Jones Samantha Kaplan Felicitas L. Koller Julius M. Wilder L. Ebony Boulware Lisa M. McElroy |
| author_facet | Christine Park Mandisa-Maia Jones Samantha Kaplan Felicitas L. Koller Julius M. Wilder L. Ebony Boulware Lisa M. McElroy |
| author_sort | Christine Park |
| collection | DOAJ |
| description | Abstract Background Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. Patients face unique barriers to referral and acceptance for organ transplant based on social determinants of health, and patients from disenfranchised groups suffer from disproportionately lower rates of transplantation. Our objective was to review the literature describing disparities in access to organ transplantation based on social determinants of health to integrate the existing knowledge and guide future research. Methods We conducted a scoping review of the literature reporting disparities in access to heart, lung, liver, pancreas and kidney transplantation based on social determinants of health (race, income, education, geography, insurance status, health literacy and engagement). Included studies were categorized based on steps along the transplant care continuum: referral for transplant, transplant evaluation and selection, living donor identification/evaluation, and waitlist outcomes. Results Our search generated 16,643 studies, of which 227 were included in our final review. Of these, 34 focused on disparities in referral for transplantation among patients with chronic organ disease, 82 on transplant selection processes, 50 on living donors, and 61 on waitlist management. In total, 15 studies involved the thoracic organs (heart, lung), 209 involved the abdominal organs (kidney, liver, pancreas), and three involved multiple organs. Racial and ethnic minorities, women, and patients in lower socioeconomic status groups were less likely to be referred, evaluated, and added to the waiting list for organ transplant. The quality of the data describing these disparities across the transplant literature was variable and overwhelmingly focused on kidney transplant. Conclusions This review contextualizes the quality of the data, identifies seminal work by organ, and reports gaps in the literature where future research on disparities in organ transplantation should focus. Future work should investigate the association of social determinants of health with access to the organ transplant waiting list, with a focus on prospective analyses that assess interventions to improve health equity. |
| first_indexed | 2024-12-20T15:29:24Z |
| format | Article |
| id | doaj.art-feaa8733ff4c4493b1fca3fade473628 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-12-20T15:29:24Z |
| publishDate | 2022-02-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-feaa8733ff4c4493b1fca3fade4736282022-12-21T19:35:40ZengBMCInternational Journal for Equity in Health1475-92762022-02-0121112010.1186/s12939-021-01616-xA scoping review of inequities in access to organ transplant in the United StatesChristine Park0Mandisa-Maia Jones1Samantha Kaplan2Felicitas L. Koller3Julius M. Wilder4L. Ebony Boulware5Lisa M. McElroy6Division of Abdominal Transplant, Department of Surgery, Duke University School of MedicineDivision of Cardiac Anesthesiology, Department of Anesthesiology, Weil Cornell MedicineMedical Center Library and Archives, Duke University School of MedicineDivision of Abdominal Transplant, Department of Surgery, University of Mississippi School of MedicineDivision of Gastroenterology, Department of Medicine, Duke University School of MedicineDivision of General Internal Medicine, Department of Medicine, Duke University School of MedicineDivision of Abdominal Transplant, Department of Surgery, Duke University School of MedicineAbstract Background Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. Patients face unique barriers to referral and acceptance for organ transplant based on social determinants of health, and patients from disenfranchised groups suffer from disproportionately lower rates of transplantation. Our objective was to review the literature describing disparities in access to organ transplantation based on social determinants of health to integrate the existing knowledge and guide future research. Methods We conducted a scoping review of the literature reporting disparities in access to heart, lung, liver, pancreas and kidney transplantation based on social determinants of health (race, income, education, geography, insurance status, health literacy and engagement). Included studies were categorized based on steps along the transplant care continuum: referral for transplant, transplant evaluation and selection, living donor identification/evaluation, and waitlist outcomes. Results Our search generated 16,643 studies, of which 227 were included in our final review. Of these, 34 focused on disparities in referral for transplantation among patients with chronic organ disease, 82 on transplant selection processes, 50 on living donors, and 61 on waitlist management. In total, 15 studies involved the thoracic organs (heart, lung), 209 involved the abdominal organs (kidney, liver, pancreas), and three involved multiple organs. Racial and ethnic minorities, women, and patients in lower socioeconomic status groups were less likely to be referred, evaluated, and added to the waiting list for organ transplant. The quality of the data describing these disparities across the transplant literature was variable and overwhelmingly focused on kidney transplant. Conclusions This review contextualizes the quality of the data, identifies seminal work by organ, and reports gaps in the literature where future research on disparities in organ transplantation should focus. Future work should investigate the association of social determinants of health with access to the organ transplant waiting list, with a focus on prospective analyses that assess interventions to improve health equity.https://doi.org/10.1186/s12939-021-01616-xOrgan transplantInequitiesDisparitiesAccess |
| spellingShingle | Christine Park Mandisa-Maia Jones Samantha Kaplan Felicitas L. Koller Julius M. Wilder L. Ebony Boulware Lisa M. McElroy A scoping review of inequities in access to organ transplant in the United States International Journal for Equity in Health Organ transplant Inequities Disparities Access |
| title | A scoping review of inequities in access to organ transplant in the United States |
| title_full | A scoping review of inequities in access to organ transplant in the United States |
| title_fullStr | A scoping review of inequities in access to organ transplant in the United States |
| title_full_unstemmed | A scoping review of inequities in access to organ transplant in the United States |
| title_short | A scoping review of inequities in access to organ transplant in the United States |
| title_sort | scoping review of inequities in access to organ transplant in the united states |
| topic | Organ transplant Inequities Disparities Access |
| url | https://doi.org/10.1186/s12939-021-01616-x |
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