Global inequities in organ transplantation, 2008–2023: trends, unmet need, and policy implications

TL;DR

Organ transplants are increasing globally, but access remains highly unequal, with most growth in wealthy countries and significant gaps in poorer regions.

Contribution

This study provides the first comprehensive analysis of global organ transplant trends and inequities from 2008 to 2023.

Findings

Global transplants increased by 76%, but per-million population rates remain extremely low in low-HDI countries.

Kidney transplants dominate global activity, while lung transplants show the fastest growth.

Japan and Mongolia show outlier trends, highlighting the role of policy and sociocultural factors.

Abstract

Solid organ transplantation is the definitive treatment for end-stage organ failure, yet access is highly inequitable worldwide. Comparable long-term evidence across organs, regions, and development settings remains limited.

Data from the WHO Global Observatory on Donation and Transplantation (GODT) for six solid organs (2008–2023) were analyzed. Per-million population (PMP) rates and the estimated annual percentage change (EAPC) were calculated; disparities by Human Development Index (HDI), WHO regions, and Global Burden of Disease 2021 (GBD 2021) regions were quantified using the slope index of inequality (SII) and concentration index (CI); and transplant capacity gap was estimated by comparing observed volumes with PMP benchmarks from very-high-HDI countries.

Global transplants rose 76% (101,990–179,091); PMP increased 15.1 → 23.1 (EAPC 2.5%). Kidney transplantation accounted for 65% of all solid organ transplants in 2023, representing the largest share of global activity; lung transplantation showed the fastest relative growth. Two procedures declined globally—pancreas-only transplantation and small-bowel transplantation. Absolute volumes were highest in the USA, China, and India, but PMP ranged from >120 (Spain, USA) to <5 in most low-HDI countries. Growth accrued mainly in very-high-HDI settings, with minimal contribution from low-HDI regions. Japan showed persistently low rates despite very-high-HDI status, whereas Mongolia achieved the world's highest EAPC despite low HDI. Inequality widened by SII (55.9 → 73.9), while CI fell modestly (0.61 → 0.53). Benchmarking indicated the largest transplant capacity gap for kidney (>200,000 procedures), then liver (>80,000) and heart (>30,000); coverage remained <10% in most low-HDI countries.

Global activity increased substantially but gains concentrated in very-high-HDI countries, and inequities persist. Outlier trajectories highlight sociocultural and policy factors beyond economic development. Large benchmark-based gaps—especially for kidney, liver, and heart—remain across low- and middle-HDI settings. Strategic investment in policy, infrastructure, and integration of transplantation within universal health coverage is essential to advance equitable access.

The Integrated Fund4150102990-58803-0/Prof. Dr. Z.K. Chen; The Fund of Guangzhou Key Laboratory of Organ Transplantation2025A03J4036.

Figures