*Purpose: Hispanics/Latinos are disproportionately less likely than non-Hispanic whites to receive a live donor kidney transplant (LDKT). Cultural beliefs and linguistic barriers contribute to LDKT disparities. We implemented the Northwestern Medicine’s® Hispanic Kidney Transplant Program (HKTP), a culturally and linguistically competent transplant center-based intervention, which has been associated with an increase in Hispanic LDKTs and reduction in disparities, at two geographically distinct US transplant centers in the South and Southwest. This paper presents insights into facilitators and barriers to implementing culturally competent care in transplant centers.

*Methods: During the implementation phase (2016), we conducted site visits involving in-depth interviews and group discussions, and a learning collaborative in-person 2-day meeting and teleconference call with transplant stakeholders (e.g., clinicians, administrators, and staff) to assess facilitators and barriers to implementation guided by the Consolidated Framework for Implementation Research (CFIR) conceptual framework. Interviews and discussions were analyzed by thematic analysis.

*Results: A total of 51 stakeholders participated in 24 interviews and 33 group discussions across both sites. The implementation of culturally competent care illuminated facilitators and barriers to implementation not previously considered by CFIR. Facilitators included a common belief that providing the HKTP was “the right thing to do” and a recognized need for Hispanic bicultural and bilingual providers to optimize patient-provider relationships in ways not possible through interpreters. Barriers unique to the implementation of culturally competent care arose, including: 1) a commitment to equal care as opposed to equitable care, 2) concerns about how HIPAA regulations prohibit family involvement in provider-patient interactions, and 3) the value placed on Spanish-language skills; stakeholders were unaware of which of their staff were native Spanish speakers and considered it too difficult to train clinicians in Spanish or find suitable Hispanic clinician applicants. While stakeholders were generally aware of their center’s patient volume data and payer mix, they lacked knowledge about their center’s disparities in LDKT rates, and almost all lacked knowledge of their center’s disaggregated patient volume data by ethnic/racial background.

*Conclusions: Our findings suggest that culturally and linguistically competent transplant interventions may require centers to collect and review disaggregated data to set institutional goals toward increasing ethnic/racial equity in LDKT access and outcomes. Transplant centers must address equity rather than equality to foster culturally competent care, and should be held accountable for addressing ethnic/racial disparities.

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