Sexual and Gender Minorities in Organ and Tissue Donation and Transplantation (OTDT): A Survey of Canadian OTDT Health Care Workers

Purpose: Sexual and gender minorities (SGMs) experience inequities and harms in organ and tissue donation and transplantation (OTDT) systems. We surveyed OTDT health care workers (HCWs) to measure relevant self-reported practices, characterize opinions on potential equitable policy alternatives, and understand current capacities to provide SGM-specific care. Methods: We conducted a cross-sectional survey of Canadian OTDT HCWs (August to October 2024). Descriptive data are presented as counts and proportions. Sub-groups included organ donation, transplantation, and eye/tissue program respondents. Results: Of 600 eligible respondents, we analyzed responses from 123 (21%) completed surveys. Respondents were mainly coordinators (61%) and physicians (25%). Most respondents felt that the Health Canada policy that considers men who have sex with men (MSM) in the past 12 months at increased risk of transmitting human immunodeficiency virus (HIV) through donation and prohibits all tissue and organ donation except through an exceptional distribution process as discriminatory (97%, n = 119/123). Most respondents felt that gender-neutral, behavior-focused donor eligibility assessments would confer low or no risk for donor-derived infections in transplant recipients (77%, n = 95/123). Respondents had varied opinions on how HIV pre-exposure prophylaxis (PrEP) should influence donor risk assessments. Few respondents reported receiving any targeted training specific to cultural humility in the care of Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer and more (2SLGBTQ+) patients in the organ or tissue donation system (11%, n = 14/123). Conclusions: Most respondents found current SGM-relevant OTDT policies to be unnecessarily discriminatory against SGMs and non-evidence-based, and they supported equitable policy revision. Respondents favor gender-neutral donor risk assessments that focus on behaviors specifically associated with an increased likelihood of HIV acquisition.