Abstract Lancet Series 3: Advances in solid organ transplantation, such as improved organ preservation technologies and novel approaches to immunosuppression management, have the potential to improve outcomes in transplant recipients. However, despite these developments, there are persistent disparities in access to transplantation across, and within, certain countries.
Low-income and middle-income countries have particularly low rates of transplantation, as well as less access to new technologies, mainly due to limited infrastructure and resources. Additionally, marginalised groups, especially racially and ethnically minoritised people and individuals from low socioeconomic backgrounds, might be most susceptible to these inequities worldwide. In this Series paper, we focus on how policies can advance equity in the field of transplantation, both within individual health systems and across different countries. We propose policy solutions to make progress towards equity in access to transplantation and better outcomes for all patients with endstage organ disease who could benefit from transplantation.
Objectives
Understand how barriers to transplantation emerge at different steps across the patient journal from referral to evaluation through transplantation and follow-up care
Describe global variation in access to transplantation, including differences in access to living donor versus deceased donor transplantation
Describe global variation in access to high quality care after transplantation
Describe how national policies can improve transplant equity, but must be tailored to the local context
Identify knowledge gaps in how transplant equity might be achieved in the future
supporting material
Jaure A., Reese P. Solid Organ Transplantation 3: Policy innovations to advance equity in solid organ transplantatione. The Lancet. Accepted, In production.
Clinical Director, Transplant Infectious Disease
Department of Medicine, Infectious Disease Division
Massachusetts General Hospital
Camille Nelson Kotton is the clinical director of the Transplant and Immunocompromised Host Infectious Diseases Program in the Infectious Diseases Division at Massachusetts General Hospital, and an associate professor of medicine at Harvard Medical School in Boston, MA. She has worked in the field of transplantation since 2001. She was the president of the TTS Transplant Infectious Disease Section (2007-2014), chair of the American Society of Transplantation Infectious Disease Executive Committee (2014-2016), and served as councilor for TTS (2020-2024), on the TTS Fundraising Committee, and co-chair of the TTS Education Committee since 2022. She has led four versions of the TTS-supported International Consensus Guidelines on CMV Management after Solid Organ Transplant (2008, 2012, 2017, 2024) and co-led the Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation (2024), all published in Transplantation, where she serves as associate editor. She has a special interest in international transplant work and was integrally involved in the TTS-supported guidelines on Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America (2018) and South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors (2023).
Nephrologist, Westmead Hospital Clinician Researcher
Westmead Institute for Medical Research
Jen is a transplant nephrologist working at Westmead Hospital and has an active research portfolio in cell therapies and transplant genomics at the Westmead Institute for Medical Research.
Diretor, Center for Transplant Science
Vanderbilt University, Nashville, TN, USA
Peter Reese, MD, PhD directs Vanderbilt’s Center for Transplant Science. He is a transplant nephrologist. His research aims to improve access to transplant and the care of solid organ transplant recipients with tools from epidemiology, ethics and policy. His scientific work includes co-leading pioneering trials that demonstrated the safety and efficacy of transplanting organs from donors with hepatitis C virus infection into uninfected recipients. For his contributions to transplant science and ethics, he received a Presidential Early Career Award for Scientists and Engineers at the White House and was elected member of the American Society for Clinical Investigation. Dr. Reese is past Chair of the Ethics Committee for the United Network for Organ Sharing (UNOS), which oversees US organ allocation and transplant regulation. His mission encompasses energetic support of talented and motivated young researchers at all stages of training.
Head: Transplantation Services
University of Cape Town; Groote Schuur Hospital
TTS Immediate Past President
Alexandre Loupy, MD, PhD, is Professor of Nephrology and Epidemiology at Necker Hospital and Université Paris Cité, where he leads the Paris Institute for Transplantation & Organ Regeneration (PITOR). He coordinates a national transplant network (11 centers, 8000+ patients) and co-chairs the Banff classification. His research focuses on precision diagnostics in allo- and xenotransplantation, including risk prediction and stratification, immune response, and organ rejection. He has pioneered data-driven methods that reshaped transplant medicine and received major national and European grants in transplant science, including ERC Consolidator Grant 2023 for AI-Care.
Associate Editor, American Journal of Transplantation
Abdominal Transplant Surgeon;
Assistant Professor of Surgery and Population Health Sciences
Duke University, Durham
Lisa McElroy, MD, MS is an Assistant Professor of Surgery and Population Health Sciences and Director of Health Services Research for the Department of Surgery at Duke University. In 2022 she was selected as the Inaugural Onyekwere E. Akwari Endowed Assistant Professor in Surgery.
Dr. McElroy completed her general surgery residency at the Medical College of Wisconsin and a fellowship in abdominal transplant surgery at the University of Michigan. She received her research training via a T32 postdoctoral research fellowship at Northwestern University, where she also earned a Master of Science in Health Services and Outcomes Research through the Institute for Public Health and Medicine.
Dr. McElroy’s current research projects, which aim to improve access to transplantation by optimizing processes of care, have been funded by the Robert Wood Johnson Foundation, the American Surgical Association Foundation, and the National Institutes of Health. She has authored more than 100 peer reviewed scientific papers and serves as an Associate Editor of the American Journal of Transplantation, vice chair of the American Society of Transplant Surgeons grants committee and Vice Chair of the OPTN Data Advisory Committee.
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