Clinician Perspectives on Barriers and Facilitators to Abdominal Organ Transplant Access.

Importance: Organ transplant is lifesaving for patients with end-stage organ disease; however, prominent disparities exist in waiting list placement among racial and ethnic minoritized and socially deprived populations. The process of determining transplant candidacy involves a multidisciplinary team of clinicians and staff who possess unique insight into the multilevel factors influencing equitable waiting list access. Objective: To understand clinician and staff perspectives on barriers and facilitators to transplant access and inform targeted strategies for transplant center-based interventions. Design, Setting, and Participants: This qualitative descriptive study consisted of semistructured interviews of clinicians and staff involved in the abdominal transplant evaluation and selection process. The study was conducted at Duke University, Houston Methodist, and University of Michigan between September 1, 2022, and August 25, 2023. The study participants consisted of clinicians and staff (physicians, nurse coordinators, financial coordinators, social workers, psychologists, and administrators) who were purposively sampled from each institution's abdominal transplant program. Data were analyzed from January 15, 2024, to July 30, 2025. Main Outcomes and Measures: Thematic analysis was performed using a multistage deductive and inductive approach. Themes and illustrative quotations are presented. Results: Interviews included 52 participants (24 physicians [46.2%]; 18 transplant coordinators [34.6%]; 3 dieticians [5.8%]; 3 social workers [5.8%]; 2 transplant referral intake specialists [3.8%]; and 2 pharmacists [3.8%]). Eleven themes related to transplant access were identified from the semistructured interviews, which were categorized into 6 barriers and 5 facilitators. Barriers to access included inadequate caregiver resources, costs of care, difficulty with navigating the transplant process, clinician bias, workflow inefficiencies, and social and environmental drivers. Facilitators to access included strong patient support systems, promotion of patient literacy and capacity, patient engagement and interaction, clinician commitment to patient success, and community-based outreach and education. Conclusions and Relevance: This qualitative study of transplant clinician and staff perspectives affirms existing knowledge of patient-level barriers and facilitators to transplant access. Evaluation of perspectives across all clinical and nonclinical staff roles involved in the transplant evaluation and selection process provides novel elucidation of how transplant center-level processes may act as barriers and facilitators for patients. Key opportunities at the patient, clinician, and systems levels are identified for the development of targeted, center-driven interventions to improve transplant access through amplification of existing patient-level programs.