Evidence map›Paper›PMID 42813513›Full record

ArticleTransplantation direct2026

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

Andrea Herrera-Gayol, Medhat Askar, Hari S Meshram, Gabriel E Gondolesi, Nithya Krishnan, Karen M Dwyer, Kumud Dhital, Stephen Beed, Peter Stock, Vivek B Kute and 25 more

Abstract read
In one paragraph

Article in Transplantation direct, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Answers From the World of Transplantation?Transplantation direct · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

35 authors.

Andrea Herrera-GayolAHG Consultant, Westmount, QC, Canada.
Medhat AskarDepartment of Pathology and Laboratory Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
Hari S MeshramDepartment of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Ahmedabad, India.
Gabriel E GondolesiDivision of Transplantation, MedStar Georgetown Transplant Institute, Georgetown University, Washington, DC.
Nithya KrishnanDivision of Nephrology, University Hospitals Coventry & Warwickshire, Coventry University, United Kingdom.
Karen M DwyerDivision of Nephrology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia.
Kumud DhitalDepartment of Cardiothoracic Surgery, Apollo Hospitals, Chennai, India.
Stephen BeedDepartment of Critical Care, Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, NS, Canada.
Peter StockDepartment of Surgery-Transplant Services, University of California, San Francisco, School of Medicine, San Francisco, CA.
Vivek B KuteDepartment of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Ahmedabad, India.
Carlos DiazNephrology Section, Instituto Universitario CEMIC, Buenos Aires, Argentina.
Mohammad GhnaimatDivision of Nephrology, Al-Rasheed and Specialty Hospitals, Amman, Jordan.
Gamal SaadiNephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt.
Mario Abbud-FilhoDepartment of Transplant, Organ Transplantation Center, Hospital de Base, Funfarme, São José do Rio Preto, SP, Brazil.
Ban Hock TanDepartment of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
John GillDivision of Nephrology, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
Jeffrey SchiffDivision of Nephrology and Multi-Organ Transplant Program, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Elias J ElenjickalDepartment of Medicine, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
Mirela BušicSoHO Standards Department of Biological Standardisation, OMCL Network and HealthCare (DBO) EDQM, Council of Europe, Strasbourg, France.
Lara Danziger-IsakovDepartment of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Hiroto EgawaDepartment of Surgery, Hamamatsu Rosai Hospital, Shizuoka, Japan.
Gustavo FerreiraRenal Transplant Program, Santa Casa de Misericordia de Juiz de Fora, Juiz de Fora, Brazil.
Paola Garcia-PadillaDepartment of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
Jongwon HaDepartment of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Oscar ImventarzaLiver Transplant Program, Department of Surgery, Hospital Argerich, Buenos Aires, Argentina.
Wayne J HawthorneDepartment of Surgery, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead Institute for Medical Research, Westmead, NSW, Australia.
Marti ManyalichDonation and Transplantation Institute, Barcelona, Spain.
Helen PilmoreDepartment of Renal Medicine, Auckland City Hospital, University of Auckland, Auckland, New Zealand.
Marina BerenguerHepatology and Liver Transplantation Unit, Hospital Universitario la Fe-IIS La Fe Valencia; CiberEHD and University of Valencia, Valencia, Spain.
Beatriz Domínguez-Gil GonzálezOrganización Nacional de Trasplantes, Madrid, Spain.
Jean TchervenkovDepartment of Surgery, Division of General Surgery, Multi-Organ Transplant Program, McGill University, Montreal, QC, Canada.
Shaifali SandalDepartment of Medicine, Division of Nephrology, Multi-Organ Transplant Program, McGill University, Montreal, QC, Canada.
Marcelo CantarovichDepartment of Medicine, Division of Nephrology, Multi-Organ Transplant Program, McGill University, Montreal, QC, Canada.ORCID https://orcid.org/0000-0002-4766-3333
members of the TTS Working Group and the participating national, regional, and international societies/organizations
members of the TTS Working Group and the participating national, regional, and international societies/organizations

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Identifiers

PMID42813513
PMCPMC13623274

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.