Health Equity: Bridging Inequities in Transplantation: From Insight to Impact

About the project 

Access to organ transplantation, and the outcomes that follow it, are not equal across Europe. Differences in donation, referral, evaluation, listing, follow-up and support mean that a patient’s chances can depend on where they live, the language they speak, their socioeconomic circumstances and other social determinants of health, rather than on medical need alone. 

The ESOT Health Equity Projects initiative is a key implementation pathway for the mission outlined in ESOT Manifesto: Tackling Inequalities in Organ Transplantation. It brings together clinicians, researchers, patient representatives and policymakers to identify systemic disparities in transplantation, enable practical change at the local level, and support stakeholders across the transplant community through co-created solutions and high-level advocacy. 

The project works from a shared, transplant-specific definition of health equity: 

Equity in transplantation means fair access, fair processes and fair outcomes for all patient groups, regardless of race, ethnicity, sex, geography, socioeconomic status, language, disability or other social determinants of health. 

Equity is measured across four connected categories: 

Equitable access. All eligible patients have comparable opportunities to enter and progress through the transplant pathway. 

Health literacy. Patients can understand and act on information about transplantation, supported by accessible, culturally relevant materials and decision aids. 

Equitable treatment. Clinical decisions at every stage rest on medical need and expected benefit, not on social or demographic factors. 

Equitable outcomes. Patients experience comparable post-transplant outcomes across demographic and socioeconomic groups, including survival, quality of life, and long-term follow-up.
 

Project aims 

The project aims to: 

• Raise awareness of the equity of access to transplantation across the European community. 

• Build shared definitions and a common understanding of health equity. 

• Capture regional realities and structural differences between centres and countries. 

• Reduce bias in patient evaluation and communication. 

• Create scalable tools, including an equity self-diagnostic tool and a Transplant Equity Atlas. 

• Develop policy recommendations to improve access to transplantation. 

Project activities 

The initiative is delivered through connected workstreams: a literature review, a pan-European survey feeding Transplant Equity Atlas, in-person Equity Labs, and an equity self-diagnostic tool for transplant centres. 

Literature review 

A structured review of the available literature will map what is already known about transplant equity in the European context. It clarifies which equity-related domains, such as health literacy, psychosocial evaluation and organ access, have been studied and where evidence gaps remain, and will help shape the survey framework, the Equity Labs, and the diagnostic tool. 

Survey & Transplant Equity Atlas 

A pan-European survey will identify inequalities in organ transplantation across Europe and inform a Transplant Equity Atlas, together with policy recommendations to improve access. The atlas is intended for policymakers, patient advocates and transplant societies. It draws on a focused set of headline indicators combined with a hybrid data model that pairs national focal points with established European data sources. The final goal is an interactive atlas featuring country pages, maps and dashboards, one-page country briefs, and a transparent methodology, alongside an advocacy pack. 

Equity Labs 

Equity Labs are in-country, in-centre workshops that translate data on transplant disparities into practical, co-created solutions. Each lab brings together local clinicians, coordinators, psychologists, patient representatives and community partners to map challenges across the transplant journey, understand centre-level and regional variation, and identify structural, cultural and organisational barriers. The labs also generate inputs for the equity self-diagnostic tool and the Europe-wide survey. 

Equity self-diagnostic tool 

A digital self-diagnostic tool will help transplant centres assess their own equity performance across organisational readiness, assessment processes, health literacy support, resource availability, follow-up capacity and culturally sensitive care. Its purpose is not to rank centres but to raise awareness and highlight improvement priorities. The tool will be validated using data gathered in the Equity Labs and will support the future development of an ESOT Equity Dashboard. 

Key milestones 

Steering Committee 

Acknowledgement 

This project and its associated scientific and educational assets have been developed with the support of unrestricted funds from Takeda and Chiesi. 

ESOT retains responsibility for the project’s scientific direction, content development and educational activities.