Global strategies to improve equitable access to heart and lung transplantation- ISHLT Consortium Report

Many inequities exist in the global access of heart and lung transplantation. Few studies have identified global strategies to implement equitable access to heart or lung transplantation.

Members of the International Society for Heart and Lung Transplantation (ISHLT) developed a consortium to identify strategic priorities to improve global access to heart and lung transplantation according to the Capability, Opportunity, Motivation- Behavior Change Wheel Model (COM-B/ BCW), an implementation science framework. Initial workshops were held at the ISHLT Scientific Sessions and refined with follow-up focus group meetings of consortium members from 2025 through 2026.

Focus 1 was to improve quality of transplant data for access and outcomes; prioritized behavior included: 1) improving collection of social determinants of health, race, and ethnicity data, and 2) collecting data on patients referred but not listed. Focus 2 was to improve transplant access to diverse racial and ethnic populations; prioritized behavior included: 1) increasing transparency regarding candidacy and allocation, and 2) improving awareness regarding diverse patient and community needs for transplant consideration. Focus 3 was to improve access with patient-centered approaches; prioritized behavior included: individualizing a comprehensive patient assessment and plan. Focus 4 was to develop transplant programs in under-resourced countries; prioritized behaviors included: 1) developing a national or regional heart and lung transplant infrastructure and workforce plan, and 2) identifying and designating transplant capable centers as pilot hubs or consortium nodes.

An ISHLT consortium developed and prioritized strategies for behavior change to improve global access to heart and lung transplantation. These strategies may form the basis of global quality improvement and implementation research studies for transplantation equity.