Geography, inequities, and the social determinants of health in transplantation

Abstract

Among the causes of inequity in organ transplantation, geography is oft-cited but rarely defined with precision. Traditionally, geographic inequity has been characterized by variation in distance to transplant centers, availability of deceased organ donors, or the consequences of allocation systems that are inherently geographically based. Recent research has begun to explore the use of measures at various geographic levels to better understand how characteristics of a patient’s geographic surroundings contribute to a broad range of transplant inequities. Within, we first explore the relationship between geography, inequities, and the social determinants of health. Next, we review methodologic considerations essential to geographic health research, and critically appraise how these techniques have been applied. Finally, we propose how to use geography to improve access to and outcomes of transplantation.