How important is social support in determining patients' suitability for transplantation? Results from a National Survey of Transplant Clinicians

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

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations


Background National guidelines require programmes use subjective assessments of social support when determining transplant suitability, despite limited evidence linking it to outcomes. We examined how transplant providers weigh the importance of social support for kidney transplantation compared with other factors, and variation by clinical role and personal beliefs. Methods The National survey of the American Society of Transplant Surgeons and the Society of Transplant Social Work in 2016. Using a discrete choice approach, respondents compared two hypothetical patient profiles and selected one for transplantation. Conditional logistic regression estimated the relative importance of each factor; results were stratified by clinical role (psychosocial vs medical/surgical providers) and beliefs (outcomes vs equity). Results Five hundred and eighy-four transplant providers completed the survey. Social support was the second most influential factor among transplant providers. Providers were most likely to choose a candidate who had social support (OR=1.68, 95% CI 1.50 to 1.86), always adhered to a medical regimen (OR=1.64, 95% CI 1.46 to 1.88), and had a 15 years life expectancy with transplant (OR=1.61, 95% CI 1.42 to 1.85). Psychosocial providers were more influenced by adherence and quality of life compared with medical/surgical providers, who were more influenced by candidates' life expectancy with transplant (p<0.05). For providers concerned with avoiding organ waste, social support was the most influential factor, while it was the least influential for clinicians concerned with fairness (p<0.05). Conclusions Social support is highly influential in listing decisions and may exacerbate transplant disparities. Providers' beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice.

Original languageEnglish (US)
Pages (from-to)666-674
Number of pages9
JournalJournal of Medical Ethics
Issue number10
StatePublished - Oct 2018


  • allocation of organs/tissues
  • decision-making
  • social aspects
  • social work
  • surgery

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Health(social science)
  • Arts and Humanities (miscellaneous)
  • Health Policy


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