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Current status and geographic inequities in solid organ and corneal transplantation in Ecuador (2010–2022)

evidence-based-medicine
public-health
surgery-and-surgical-specialties

Abstract

Background: Organ and tissue transplantation is an essential therapy for end-stage disease. However, in Ecuador, systematic evidence on waiting list dynamics, demographic and clinical patterns, and equity in access remains scarce. The absence of comprehensive analyses has limited the capacity to identify disparities and to inform evidence-based allocation policies.

Objective: This study aimed to characterize the national transplant waiting list in Ecuador from 2010 to 2022, to assess demographic, clinical, and geographic disparities to provide insights into donor–recipient compatibility and equity in allocation.

Study Design: We conducted a retrospective cohort study using data from the Ecuadorian National Institute for Organ and Tissue Donation and Transplantation (INDOT). The dataset included all patients listed for kidney, liver, heart, lung, and corneal transplants between 2010 and 2022. Variables analyzed included age, sex, comorbidities, geographic origin, and mortality while on the waiting list. Temporal trends were evaluated, including the impact of the COVID-19 pandemic. Descriptive statistics were used to characterize the population, and mortality proportions were compared across organ types.

Results: A total of 6,523 individuals were listed during the study period: 59% for corneal, 35.7% for kidney, 5% for liver, 0.3% for heart, and 0.1% for lung transplantation. Men predominated in corneal (72.3%) and heart (72.7%) lists, whereas women predominated in kidney (61%) and liver (57%) lists. Mortality while on the waiting list was highest among liver (15.5%) and kidney (9.1%) candidates, compared with 1.7% for corneal candidates. Geographic disparities were evident, with most transplant programs concentrated in Quito, Guayaquil, and Cuenca. The COVID-19 pandemic caused a sharp decline in transplant activity in 2020, followed by a partial recovery in 2022.

Conclusions: This nationwide study demonstrates persistent inequities in Ecuador’s transplant system, reflected in geographic concentration, sex-specific trends, and mortality among kidney and liver candidates. Findings highlight the urgent need to expand programs beyond major cities, strengthen donor identification strategies, and integrate clinical, socioeconomic, and genetic factors into allocation policies.

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