*Purpose: Over 10 million inmates exist in prison worldwide, with United States accounting for over fifth of this population. The number of inmates with ESRD is on the rise, creating an ethical issue of their access to kidney transplantation (Ktx). This multinational study was conducted to survey the current position of transplant centers in: US, Canada, United Kingdom, Australia and New Zealand.

*Methods: Active Transplant centres across all of these countries were contacted. Calls were made to each center (max of 3 attempts) over a two-week period. Centres were asked a set of standardized questions and their responses were recorded.

*Results: USA: 201/239 centres responded and only 39/201 (19%) said they currently perform transplants for prisoners. The majority cited hospital policy as a limiting factor to transplantation. One UNOS region in US was identified as having no centres that perform transplants on inmates despite having a state with the 2nd largest number of inmates (Texas). UK: 13/24 (55%) centres agreed to have done transplants for prisoners. Lack of experience was cited 25% of the time as a reason for refusal. In Canada: 4/25 (16%) centres said they do transplants on prisoners. 48% of transplant centres failed to provide an answer on why they didn’t transplant inmates. In Australia and New Zealand: 5/20 (25%) centres admitted to performing transplants on prisoners. Notably, across all nations most centres could not identify another cente that would transplant inmates.

*Conclusions: Inmates in the western world are protected by the laws that ensure their access to health care, with majority legally eligible for KTx. This multinational study concludes that inmates have very poor access to KTx. Except for UK, where more than half of the centers had performed a KTx on inmates, majority of centers in other nations have no such experience. International and national consensus guidelines are warranted across the nations to address this issue. Meanwhile, regional Governmental and Health organizations need to ensure that all prisons with ESRD inmates have affiliation with a designated transplant site.

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