Excluding patients from transplant due to social support: Results from a national survey of transplant providers. Issue 1 (2nd July 2018)

• Record Type: Journal Article
• Authors: Ladin, Keren; Emerson, Joanna; Berry, Kelsey; Butt, Zeeshan; Gordon, Elisa J.; Daniels, Norman; Lavelle, Tara A.; Hanto, Douglas W.
• Is Part Of: American journal of transplantation. Volume 19:Issue 1(2019)
• Page Start: 193
• Page End: 203
• Publication Date: 2018-07-02
• Subjects: 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; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.14962
• Languages: English
• ISSNs: 1600-6135

Abstract

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. Abstract : A national study of transplant providers finds that providers perceive that nearly 10% of patients evaluated in the prior year are excluded due to inadequate social support, with significant variation by UNOS region and center, and this criteria disproportionately impacts patients of low socioeconomic status.