Introduction: The Global Observatory on Organ Donation and Transplantation (GODT) reported that <10% of the global transplantation (Tx) needs are met.
Methods: From May 2022 to March 2023, a survey was conducted, including Tx physicians and surgeons. Responders were grouped as per the mean deceased donation (DD) rate per million population (PMP) from yrs 2016-2021 (excluding 2020 due to the COVID-19 pandemic) into: 1) No DD reported, or no data provided to GODT; 2) <10; 3) 10-19.9; 4) 20-29.9; and 5) ³ 30 DD PMP. Questions about hospital structure, legislative and financial barriers were answered by program directors (PD) as “yes”, “no”, or “unsure”. Fisher exact test was used for statistical analyses.
Results: Significant answers from 150 PD out of 438 responders were the following:
Fig.1.A. Hospital structure 1. Presence of local recovery teams and 2. Local Tx coordinators working in organ donation and Tx (ODT); 3. Strategies to increase the identification of DD, 4. Availability of training programs to manage brain-dead donors, and 5. Donors after circulatory determination of death (DCD); 6. Availability of critical care capacities to manage DD, and 7. Tissue typing laboratories.
Fig.1.B. Legislation, policies, and allocation 1. Regulation of ODT activities, and 2. Brain death confirmation; 3. Policies about end-of-life care; 4. Regulatory mechanisms for donation from DCD and 5. Neurological criteria; 6. Policies on how to approach families and 7. Training counselors; 8. Need to create Tx programs, 9. ODT mandatory registries and 10. Allocation criteria for organ Tx.
Fig 1.C. Financial barriers: 1. Access to Tx, 2. Treatment of post-Tx complications, 3. Adherence to immunosuppression, 4. Gender disparity in the access to Tx.
In general, differences were mainly observed in countries with lower DD rates.
Conclusions: The results of this survey suggest that there are system-level barriers that limit access to Tx.  Tackling these challenges may contribute to increasing access to Tx globally.