Transplantation inequities among Hispanic and Latino Americans in the United States: A swim review with quantitative narrative synthesis

Background: Hispanic and Latino Americans carry a disproportionate burden of end-stage organ disease relative to their representation among transplant recipients. According to the OPTN/SRTR 2024 Annual Data Report, Hispanic/Latino patients comprised 24.18% of kidney transplant waitlist candidates yet received only 18.9% of transplants performed in 2024. Paradoxically, Hispanic/Latino recipients demonstrate consistently superior post-transplant outcomes compared to non-Hispanic White patients in both kidney and liver transplantation - a phenomenon termed the Hispanic Transplant Paradox; implying that structural barriers exclude a population that responds particularly well to transplantation when access is secured. Despite these disparities, no prior work has synthesized the full pathway from referral through post-transplant outcomes using rigorous quantitative methods.
Methods: We searched PubMed/MEDLINE as the primary database with supplementary searches targeting Embase-, CINAHL-, and Scopus-indexed content from January 2000 through May 2026. Two reviewers independently screened records; 37 peer-reviewed studies met inclusion criteria. Quality was assessed using the Newcastle-Ottawa Scale and Cochrane RoB 2.0. Individual effect estimates are reported in their original metric without pooling, following the Synthesis Without Meta-Analysis (SWiM) guideline.
Results: Hispanic/Latino patients are 26% less likely to receive any kidney transplant and up to 52% less likely to receive a living donor kidney transplant compared to non-Hispanic White patients; geographic adjustment substantially attenuates these estimates, implicating transplant infrastructure concentration as a primary driver. In a competing risk analysis of 28,278 liver transplant registrants, Hispanic/Latino patients had a 23% higher adjusted risk of waitlist removal due to death or deterioration (SHR=1.23; 95% CI: 1.13–1.34). Living donor access was strongly stratified by individual income (sHR=2.52; 95% CI: 2.03–3.12, highest vs. lowest income group). Residing in communities with ≥20% linguistic isolation was independently associated with a 29% lower probability of achieving active waitlist status (SHR=0.71; 95% CI: 0.67–0.76), with a dose-dependent gradient. OPO next-of-kin approach rates for Hispanic/Latino families were 31% lower than for White families (OR=0.69; 95% CI: 0.54–0.89) - a donor-side disparity largely unaddressed by current accountability metrics. The Hispanic Kidney Transplant Program was associated with a 70% increase in the Hispanic/Latino-to-White living donor transplant ratio (p=0.001), with effectiveness contingent on implementation fidelity.
Conclusions: Transplantation access disparities affecting Hispanic/Latino Americans are associated with structural factors - linguistic barriers, geographic concentration, socioeconomic disadvantage, allocation design, OPO practice variation, and medical distrust; not differences in clinical candidacy. Reform priorities include geographic infrastructure redistribution, OPO accountability for family approach equity, linguistically concordant care, and social determinants of health integration into OPTN registries. The Hispanic Transplant Paradox provides the clinical rationale for urgency: these reforms may benefit a population that achieves particularly favorable outcomes once structural barriers are removed.