Excluding patients from transplant due to social support: Results from a national survey of transplant providers

Keren Ladin*, Joanna Emerson, Kelsey Berry, Zeeshan Butt, Elisa J. Gordon, Norman Daniels, Tara A. Lavelle, Douglas W. Hanto

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Social support is used to determine transplant eligibility despite lack of an evidence base and vague regulatory guidance. It is unknown how many patients are disqualified from transplantation due to inadequate support, and whether providers feel confident using these subjective criteria to determine eligibility. Transplant providers (n = 551) from 202 centers estimated that, on average, 9.6% (standard deviation = 9.4) of patients evaluated in the prior year were excluded due to inadequate support. This varied significantly by United Network for Organ Sharing region (7.6%-12.2%), and by center (21.7% among top quartile). Significantly more providers used social support in listing decisions than believed it ought to be used (86.3% vs 67.6%). Nearly 25% believed that using social support in listing determinations was unfair or were unsure; 67.3% felt it disproportionately impacted patients of low socioeconomic status. Overall, 42.4% were only somewhat or not at all confident using social support to determine transplant suitability. Compared to surgical/medical transplant providers, psychosocial providers had 2.13 greater odds of supporting the criteria (P =.03). Furthermore, 69.2% supported revised guidelines for use of social support in listing decisions. Social support criteria should be reconsidered in light of the limited evidence, potential for disparities, practice variation, low provider confidence, and desire for revised guidelines.

Original languageEnglish (US)
Pages (from-to)193-203
Number of pages11
JournalAmerican Journal of Transplantation
Volume19
Issue number1
DOIs
StatePublished - Jan 2019

Funding

Foundation through their “Making a Difference” grants (PI Ladin) and the Greenwall Faculty Scholars Program (Ladin). Dr. Ladin gratefully acknowledges support by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number KL2TR001063. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Funding information This study was funded by the Greenwall Foundation through their ?Making a Difference? grants (PI Ladin) and the Greenwall Faculty Scholars Program (Ladin). Dr. Ladin gratefully acknowledges support by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number KL2TR001063. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH The authors gratefully acknowledge the support and assistance of the American Society of Transplant Surgeons and the Society for Transplant Social Work in fielding the survey and for comments during the development of the survey. The authors also gratefully acknowledge the dedicated and skilled research assistance of Meghan Olsen and statistical guidance from Jennifer Perloff. This study was funded by the Greenwall

Keywords

  • clinical decision-making
  • ethics
  • ethics and public policy
  • guidelines
  • health services and outcomes research
  • kidney transplantation/nephrology
  • organ transplantation in general
  • patient characteristics
  • recipient selection
  • social sciences

ASJC Scopus subject areas

  • Transplantation
  • Pharmacology (medical)
  • Immunology and Allergy

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