Impossible odds persist for many on organ transplant waitlist

Organ transplants hit a record high last year, but despite years of trying to level the playing field, getting a new organ is still a game of chance where your odds depend on the color of your skin, the size of your wallet and your zip code.

A recent study published in JAMA Network Open serves up a stark reminder: If you're Black, you're less likely to even make it to a lung transplant evaluation compared to your white counterparts. And this isn't just about lungs - similar patterns play out across all organ types. Journalists play a crucial role in bringing attention to organ transplant inequities and holding institutions accountable.

Researchers analyzed data from over 30,000 patients with obstructive and restrictive lung disease and found that Black individuals were 39% less likely to be evaluated for a lung transplant compared to white individuals. Even though income and location affected access to care, Black individuals still faced barriers to getting a lung transplant, no matter their neighborhood.

However, people from poorer neighborhoods were 45% less likely to get on the transplant waiting list, and 97% more likely to die, before ever receiving a new lung.

While the number of transplants for Black and Hispanic recipients grew slightly in 2024 compared to 2023, these modest gains haven't erased the deep-rooted inequities in the system.

And this isn't new. A previous study of over 42,000 kidney transplant candidates found similar racial disparities - especially for patients with complex immune system profiles. The persistence of these findings across multiple studies and time periods suggests that the U.S. transplant system is failing to provide equitable access to life-saving organs.

Meanwhile, more than 100,000 people in the U.S. remain on the organ transplant waiting list. Only about half of them will receive a transplant this year. Every inequity in this system means lives lost.

Why are these gaps still so wide?

The United Network for Organ Sharing, a nonprofit that has controlled the U.S. transplant system since 1986, has long faced criticism for mismanagement. A 2020 Senate investigation exposed outdated infrastructure, inefficiencies, and patient safety risks.

The causes of transplant inequity are deeply rooted in systemic issues. Poverty, lack of insurance, and poor access to specialized transplant centers make it harder for some patients to navigate the complex transplant process. Patients in rural or underserved areas may not even have a nearby transplant hospital.

Unconscious biases among healthcare providers also influence referral decisions, leading to fewer Black patients being evaluated for transplants. Many patients - especially in minority communities - also lack access to information about transplantation as a treatment option.

Why transplant equity matters

The ethical implications of transplant inequity are profound. At its core, the issue is about fairness. Life-saving treatments should be available to everyone - not just those with financial means or privileged access to care.

From a public health perspective, inequities in transplantation contribute to worse health outcomes and deepen existing disparities. End-stage organ failure disproportionately affects communities of color, and when they're shut out of the transplant system, it exacerbates health inequities.

There's also an economic argument: Kidney transplants are far more cost-effective than long-term dialysis. The same statement can be made for other organs and their respective treatments. Expanding access to transplantation could save healthcare dollars while vastly improving quality of life for thousands of patients.

The U.S. organ transplant system is broken. The same disparities that existed decades ago remain today. If the country is serious about closing these gaps, it will take a combination of policy changes, medical system reform and investigative journalism to drive meaningful progress.

Why, in 2025, are we still talking about transplant inequality? And more importantly - what will it take to change the story?

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