. 2025 May 29:12:20543581251331703.

doi: 10.1177/20543581251331703. eCollection 2025.

Lived Experiences of Sexual and Gender Minorities in Solid Organ Transplantation: A Best-Fit Framework Synthesis and Inductive Thematic Analysis

Murdoch Leeies^{1

2

3

4}, Carmen Hrymak^{1

2

3}, David Collister⁵, Emily Christie⁵, Karen Doucette⁶, Ogai Sherzoi⁷, Tricia Carta¹, Ken Sutha⁸, Cameron T Whitley⁹, Tzu-Hao Lee^{10

11}, Matthew J Weiss^{4

12

13}, Sonny Dhanani¹⁴, Julie Ho^{15

16}

Affiliations

¹ Gift of Life Program, Transplant Manitoba, Shared Health Manitoba, Winnipeg, Canada.
² Section of Critical Care Medicine, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
³ Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
⁴ Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.
⁵ Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.
⁶ Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada.
⁷ Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada.
⁸ Division of Nephrology, Department of Pediatrics, School of Medicine, Stanford University, CA, USA.
⁹ Department of Sociology, Western Washington University, Bellingham, USA.
¹⁰ Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
¹¹ Division of Abdominal Transplant, Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
¹² Transplant Québec, Montréal, Canada.
¹³ Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil, CHU de Québec, Canada.
¹⁴ Department of Pediatrics, Division of Critical Care, Children's Hospital of Eastern Ontario and University of Ottawa, ON, Canada.
¹⁵ Adult Kidney Program, Transplant Manitoba, Shared Health Manitoba, Winnipeg, Canada.
¹⁶ Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.

PMID: 40453921
PMCID: PMC12126676
DOI: 10.1177/20543581251331703

Lived Experiences of Sexual and Gender Minorities in Solid Organ Transplantation: A Best-Fit Framework Synthesis and Inductive Thematic Analysis

Murdoch Leeies et al. Can J Kidney Health Dis. 2025.

. 2025 May 29:12:20543581251331703.

doi: 10.1177/20543581251331703. eCollection 2025.

Authors

Affiliations

¹ Gift of Life Program, Transplant Manitoba, Shared Health Manitoba, Winnipeg, Canada.
² Section of Critical Care Medicine, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
³ Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
⁴ Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.
⁵ Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.
⁶ Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada.
⁷ Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada.
⁸ Division of Nephrology, Department of Pediatrics, School of Medicine, Stanford University, CA, USA.
⁹ Department of Sociology, Western Washington University, Bellingham, USA.
¹⁰ Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
¹¹ Division of Abdominal Transplant, Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
¹² Transplant Québec, Montréal, Canada.
¹³ Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil, CHU de Québec, Canada.
¹⁴ Department of Pediatrics, Division of Critical Care, Children's Hospital of Eastern Ontario and University of Ottawa, ON, Canada.
¹⁵ Adult Kidney Program, Transplant Manitoba, Shared Health Manitoba, Winnipeg, Canada.
¹⁶ Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.

PMID: 40453921
PMCID: PMC12126676
DOI: 10.1177/20543581251331703

Abstract
in English, French

Background: Organ and tissue donation and transplantation (OTDT) policies and practices lead to differential care for sexual and gender minorities (SGMs). The experiences of SGM patients and caregivers in the transplantation system have not been published. The perspectives of SGMs on how to best address existing inequities are not understood.

Objective: To characterize the lived experiences of SGM patients and caregivers in solid-organ transplant health systems, as well as the perspectives and priorities of these individuals regarding SGM-relevant policies, practices and targets for system improvements.

Methods: We conducted a series (N = 12) of one-on-one semi-structured interviews with a convenience sample of SGMs with lived experience of the OTDT system. We transcribed interviews verbatim and performed a formal qualitative analysis combining a best-fit framework synthesis and inductive thematic analysis.

Results: We revealed novel targets for action to improve inclusive care in the transplantation system directly informed by the lived experiences of SGM patients and caregivers. Targets for improvement included (1) enhancements to shared decision-making between OTDT providers and patients, (2) transparent communication from OTDT organizations, (3) data-driven donor risk assessments, (4) expanded healthcare worker training, (5) inclusive physical care spaces, (6) recommendations for transgender and gender-diverse health system planning, (7) integrated sexual and reproductive healthcare services for transplant recipients, (8) increased SGM representation in medical education and care settings, (9) SGM and OTDT intersectional support networks, and (10) structural facilitation of SGM community advocacy efforts.

Limitations: While thematic saturation was achieved with our sample, we recognize that not all SGM identities were represented. It remains likely that additional experiences, beliefs, and priorities exist in the SGM community.

Conclusions: The emergent priorities and perspectives of SGMs with lived experience of transplant systems should inform patient-centered equitable health system advancements.

Contexte: Les politiques et pratiques actuelles entourant le don et la transplantation d’organes et de tissus (DTOT) entraînent des différences dans les soins des personnes membres de minorités sexuelles et de genre (MSG). Aucun article publié ne fait état des expériences des patients et soignants membres de MSG dans le système de transplantation. Le point de vue de ces personnes sur la meilleure façon de remédier à ces inégalités est encore mal connu.

Objectifs: Caractériser les expériences vécues par les patients et soignants membres de MSG dans les systèmes de transplantation d’organes solides, et connaitre leur point de vue et leurs priorités en matière de politiques, de pratiques et de cibles d’amélioration du système pertinentes pour les MSG.

Méthodologie: Nous avons mené une série d’interviews individuelles semi-structurées (n=12) auprès d’un échantillon de commodité composé de personnes membres de MSG ayant un vécu expérientiel du système de DTOT. Nous avons retranscrit textuellement le contenu des interviews et procédé à une analyze qualitative formelle combinant une synthèse du cadre le mieux adapté et une analyze thématique inductive.

Résultats: Nous avons mis en évidence de nouvelles cibles d’action, reposant directement sur le vécu expérientiel des patients et soignants membres de MSG, pour favoriser l’inclusion dans les soins du système de transplantation. Ces cibles étaient les suivantes : 1) amélioration de la prise de décision partagée entre les prestataires de soins de DTOT et les patients; 2) communications transparentes des organismes de DTOT; 3) évaluations des risques pour les donneurs fondées sur les données probantes; 4) élargissement de la formation du personnel de santé; 5) espaces plus inclusifs pour les soins physiques; 6) recommandations pour la planification dans le système de santé pour les personnes transgenres et la diversité des genres; 7) services intégrés de santé sexuelle et reproductive pour les receveurs d’une greffe; 8) représentation accrue des MGS dans l’enseignement médical et les structures de soins; 9) réseaux de soutien croisés entre les MSG et les systèmes de DTOT; 10) facilitation structurelle des efforts pour la défense des intérêts des communautés des MSG.

Limites: Bien que nous ayons atteint la saturation thématique avec notre échantillon, nous reconnaissons que toutes les identités des MSG n’étaient pas représentées. Il est possible que d’autres expériences, avis et priorités existent dans les différentes communautés des MSG.

Conclusion: Le point de vue et les priorités émergentes des membres des MSG ayant un vécu expérientiel des systèmes de transplantation devraient guider les progrès des systèmes de santé plus équitables et centrés sur le patient.

Keywords: donor risk assessments; donor-derived infections; equity; gender identity; inclusive care; organ and tissue donation and transplantation; safety; sexual and gender minorities; sexual orientation.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Emerging targets for action. *Note.* IIRD = increased infectious risk donor; SGM = sexual and gender minorities; OTDT = organ and tissue donation and transplantation; TGD = transgender and gender diverse; HCW = healthcare worker; NAAT = nucleic acid amplification test.

See this image and copyright information in PMC

References

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Lived Experiences of Sexual and Gender Minorities in Solid Organ Transplantation: A Best-Fit Framework Synthesis and Inductive Thematic Analysis

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Lived Experiences of Sexual and Gender Minorities in Solid Organ Transplantation: A Best-Fit Framework Synthesis and Inductive Thematic Analysis

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

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Abstract in English, French

Conflict of interest statement

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Abstract
in English, French