Healthcare inequities in lung transplant patients and donors: A scoping review

Abstract

Lung transplantation has proven to be an effective treatment for end-stage lung diseases. Recognizing and acknowledging the effects of health inequities pertaining to lung transplants is important for under-resourced populations. This scoping review aims to map the extent of literature on health inequities corresponding to lung transplantation and point to knowledge gaps to direct future research. This scoping review followed guidelines from the Joanna Briggs Institute and the PRISMA extension for scoping reviews. In July 2022, we searched Ovid Embase and MEDLINE for published articles on lung transplants, published between 2011 and 2021, written in English, and examining at least one health inequity as defined by the NIH. Screening and charting were both performed in a masked, duplicate fashion. The frequency of each health inequity examined was analyzed, and findings from each included study were summarized. After screening, our sample contained 33 studies. Our findings illustrate that patients living further from lung transplant centers were less likely to be placed on the lung transplant waitlist. Further, non-white patients, women, and people who lived in low-income areas were less likely to undergo lung transplantation. Non-white patients also experienced increased mortality post-lung transplantation. Significant research gaps were found regarding the LGBTQ+ community, occupational status, income, and education level. This scoping review highlights the gaps in research regarding lung transplant inequities. To improve existing research gaps, we recommend research into the following: (1) intervention studies, (2) clinical bias, (3) donor education programs and follow-up studies, and (4) geographic information systems.