Inequities in Organ Donation and Transplantation Among Immigrant Populations in Italy: A Narrative Review of Evidence, Gaps in Research and Potential Areas for Intervention

Abstract

Immigrants from outside Europe have increased over the past two decades, especially in Southern European countries including Italy. This influx coincided with an increased number of immigrants with end-stage organ diseases. In this narrative review, we reviewed evidence of the gaps between native-born and immigrant populations in the Organ Donation and Transplantation (ODT) process in Italy. Consistent with prior studies, despite the availability of a publicly funded health system with universal healthcare coverage, non-European-born individuals living in Italy are less likely to receive living donor kidney transplantation and more likely to have inferior long-term kidney graft function compared with EU-born and Eastern European-born individuals. While these patients are increasingly represented among transplant recipients (especially kidney and liver transplants), refusal rates for organ donation are higher in some ethnic groups compared with native-born and other foreign-born referents, with the potential downstream effects of prolonged waiting times and inferior transplant outcomes. In the process, we identified gaps in relevant research and biases in existing studies. Given the Italian National Transplant Center's (CNT) commitment to fighting inequities in ODT, we illustrated actions taken by CNT to tackle inequities in ODT among immigrant communities in Italy.

Keywords: ethnic minorities; inequities; migrants; organ donation; organ transplantation.

FIGURE 1

Conceptual model of the FAITH project of the Italian National Transplant Center. The figure illustrates the centrality of shared decision making at all stages of the organ donation and transplantation process. The first communication process refers to the relationship between institutional actors and the general public/communities (1), the second to the relationship between healthcare professionals in ICUs and the family members of potential deceased donors (2), and the third to the relationship between transplant professionals and transplant candidates/recipients/(potential) living donors (3). The figure also points out that, to enable the prevention of inequities, interventions should be implemented to target not only communities and/or individuals with an immigration background, but also those who relate with them, namely, institutional actors (1), ICU (2) and transplant centers’ HCPs (3), and the contexts where these processes respectively occur [i.e., the societal context (especially relative to the healthcare system—with a focus on healthcare organizations for stages 2 and 3—and policies)]. HCP, Healthcare Professionals; ICU, Intensive Care Unit; LD, Living Donor; MEM, Migrant and Ethnic Minority; Tx, Transplant; WL, Waiting List. *Adapted and modified from Grossi and Cardillo [86].