TABLE 5.

Modifiable barriers in liver transplant evaluation at the patient and transplant‐center levels and potential transplant center solutions that may mitigate racial and ethnic disparities in listing

Modifiable barrier	Potential transplant center solution
Transplant center–level barriers
Limited review or awareness of transplant center outcomes related to equity	Setting transplant center goals on equity Reengineering team didactics and conferences to incorporate growing team understanding about health equity Data‐driven feedback/reports about outcomes to the transplant team
Unclear transplant center role/ability to address disparities	Partner with community health initiatives, mental health care professionals, and substance rehabilitation centers Collaborate with public health experts and community‐based participatory research experts Engage in health policy changes and quality metric definitions as a transplant center and leaders Resource sharing with other groups in health system (e.g., oncology)
Subjectivity and inconsistency in decision making	Data‐driven, objective decision support tools and processes Create/update and actively use easily understood protocols to increase standardization and transparency in decisions Instead of declining based on subjective factors, question how to approach objectively as a team Ensure team understands extensive and valuable prior training by social workers and their role is clear in determining psychosocial aspects of evaluation Standardize patient assessments (e.g., patient insight of disease) and patient education so all care providers meet the patient where they are
Implicit bias and personally mediated racism	Implicit bias training for individual team members Team‐based implicit bias training Building team culture and cohesion where acknowledging implicit bias is accepted and encouraged
Limited social worker resources (patient‐level barrier examples: no transportation, local psychologist)	Hire more social workers Gather, organize, support more social work resources Transparency of resources available and whom they are available for Reports back to team about how resources are being used across all populations
Limited resources for non–English‐speaking patients (patient‐level barrier example: non–English‐speaking patients)	Increase racial and ethnic diversity of transplant team through recruitment and retainment Have non–English‐speaking transplant team members (particularly coordinator, social worker) Translated materials (e.g., letters, consents) More mobile translation tools and interpreters readily available
Patient‐level barriers
Patients with low health literacy	Tools to assess and identify health literacy concerns so they can be understood and addressed Tailored patient education materials Group educational sessions (patients, caregivers/social support)
Barriers attributed to where patient lives or transportation access	Transportation vouchers Proactively (early and often) engage patient with ride assistance programs Telemedicine when feasible to reduce burden
Support system/caregiver(s) with low socioeconomic status or health literacy	Create tools to assess social support, so patient, social support, and team can better understand gaps in knowledge and resources Create tools to educate social support/caregivers about the transplant process and postoperative responsibilities