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

Background: 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. Methods: 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. Findings: 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