Medical Need, Financial Resources, and Transplant Accessibility

Abstract

This Viewpoint demonstrates that the financial measures used to place patients on the transplant waiting list is an example of structural racism and offers 3 policy shifts to address those inequities.

Caregiver Burden in Adult Solid Organ Transplantation

“…41 Adding to the stress is the threat of not being able to receive a transplant in the event of inability to pay. 42 In a qualitative study of 11 patient-family member dyads awaiting kidney transplantation, family members expressed a broad range of financial concerns, including out-of-pocket expenses, ability to pay for immunosuppressant medications, health insurance coverage, and loss of insurance benefits after transplantation. 43 Financial strain may continue after transplantation, and resources that were available before transplant, such as social workers and financial coordinators, may be less available or absent in the years after transplantation.…”

“…41 Adding to the stress is the threat of not being able to receive a transplant in the event of inability to pay. 42 In a qualitative study of 11 patient–family member dyads awaiting kidney transplantation, family members expressed a broad range of financial concerns, including out-of-pocket expenses, ability to pay for immunosuppressant medications, health insurance coverage, and loss of insurance benefits after transplantation. 43…”

Medical Need and Transplant Accessibility

“…To the Editor A recent Viewpoint discussed inequities in solid organ transplants in the US and presented policy proposals to ameliorate these disparities. However, an additional barrier to transplant accessibility that should be considered is the stigma and ableism faced by individuals with intellectual and developmental disabilities (IDD).…”

“…Transplant coordinators often incorrectly believe that people with IDD will be unable to adhere to postoperation management requirements, despite data showing that patients with IDD who underwent solid organ transplants had 1- and 5-year survival rates similar to those without IDD . The Viewpoint authors proposed mandating collection of patient data throughout the pretransplant process to expose disparities that may occur during the transplant evaluation stage. This data collection recommendation should be expanded to include disability status, and an annual comprehensive review of transplant centers should be performed to understand how IDD, race, and socioeconomic status affect transplant rates.…”

Medical Need and Transplant Accessibility—Reply

“…In Reply We read with great interest the Letter to the Editor by Mr Kumar in response to our Viewpoint, which highlighted that the financial evaluation conducted as part of transplant candidacy evaluation is unjust and perpetuates racial and socioeconomic disparities in health outcomes. This is just one example of how the transplant evaluation process leads to the systematic exclusion of certain groups of people from receiving a potentially lifesaving transplant.…”