Identifying inequities in lung transplantation: a call for strategies and future research

Innovations in organ preservation, surgical technique, and post-operative care have transformed solid organ transplantation. As organ transplantation becomes more common, potential racial, ethnic, and socioeconomic inequities in the referral and selection process are also emerging. Research studies highlight that patients from minoritized and low socioeconomic groups experience lower rates of referrals, reduced access to the transplant waitlist, higher rates of postoperative complications, and higher mortality rates for cardiothoracic (lung/heart) and abdominal (liver/kidney/pancreas) transplants. Yet, the drivers of these inequities are understudied and thus poorly understood. Strategies that address the root causes and mitigate these inequities are urgently needed. The purpose of this manuscript is not to be a systematic review, partially because there is limited research in this area, but to lay a roadmap towards equity in lung transplant. We highlight the available literature on lung transplantation inequities, identify critical needs, and propose strategies for the next steps. Our goal is to urge a call to action for the research community to systematically address the research in lung transplant disparities, and for health systems, organizations, and policymakers to implement the organizational and health system changes to meaningfully reduce these disparities.