Structural Barriers Underlying Kidney and Liver Transplant Inequity in Hispanic Americans

Hispanic patients in the United States experience a disproportionate burden of end-stage kidney and liver disease, yet they continue to encounter disparities across multiple stages of the transplantation pathway. This narrative review synthesizes evidence on transplant referral, evaluation, waitlisting, organ allocation, living and deceased donation, structural barriers, interventions, and posttransplant outcomes among Hispanic patients. National and regional studies demonstrate persistent inequities whose magnitude varies by organ, stage of care, geographic region, and policy era, with reduced access to both deceased-donor and living-donor kidney transplantation reported among Hispanic adults and children relative to their White counterparts. Linguistic isolation, geographic variation in organ availability and transplant infrastructure, socioeconomic disadvantage, insurance limitations, medical distrust, and organ-procurement practices may contribute to these disparities. Culturally and linguistically concordant programs have improved transplant knowledge, waitlist access, and living-donor transplantation in selected settings. Despite reduced access, Hispanic kidney and liver transplant recipients frequently demonstrate outcomes comparable with or better than non-Hispanic White recipients, although the mechanisms underlying this pattern remain uncertain. Because several major studies use overlapping national registry populations, their findings are best interpreted as convergent rather than fully independent evidence. Structural interventions across referral, evaluation, language access, geography, financial support, organ procurement, and transplant-center practice may improve transplantation equity.