System-level Barriers Reducing Access to Transplantation: Results of a Global Survey

Global organ shortage is well documented; yet systemic barriers constraining access to transplantation remain poorly defined. Our study aimed to identify and map these barriers.

A web-based survey was conducted from May 2022 to March 2023 among physicians and surgeons involved in organ donation and transplantation (ODT) from transplantation societies worldwide: (1) Hospital structure, legislation and policies, and financial barriers, addressed to program directors; (2) Questions on education on ODT directed to all participants, and questions about donor acceptance for transplant specialists; (3) Questions on donor identification for critical care specialists and questions about organ acceptance directed to transplant specialists; (4) Demographic questions for everyone. Respondents were grouped according to the mean deceased donation (DD) rate per million population from years 2016 to 2019 and 2021: Group (G) 1 (G1) No DD reported, or no data provided to global observatory on donation and transplantation; (G2) <10 DD per million population; (G3) 10-19.9; (G4) 20-29.9; (G5) ≥30.

We present answers from program directors. There were 150 program directors from 438 respondents. Financial barriers ranked highest, negatively affecting access to transplantation worldwide. G1 indicated the highest percentage of challenges. Those from G4 and G5 provided the least amount of challenges; however, training programs remain areas for improvement. Responses from G2 and G3 were similar, positioned between those from G1, and G4 and G5.

The organ shortage emergency is exacerbated by parallel system-level deficiencies. This global survey identifies specific, actionable deficits that must be addressed to build equitable transplant systems worldwide.