Adults with disabilities face disparities in kidney transplantation
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Adults with intellectual and developmental disabilities and end-stage kidney disease are less likely to be evaluated to kidney transplantation compared to peers without disabilities, according to data published in JAMA Surgery.
“There’s a growing demand for organ transplants that outpaces the supply of donor organs, requiring transplant centers to prioritize which patients to put on transplant waitlists,” Brittany N. Hand, PhD, assistant professor at the school of health and rehabilitation science at Ohio State University, said in a press release. “But [intellectual and developmental disabilities] IDD should not categorically disqualify adults from transplants. Our findings show that despite existing protections, like the Americans with Disabilities Act, people with IDD continue to be discriminated against in the organ transplant process. This underscores the need for anti-discrimination initiatives to promote equitable care for this population.”
In a retrospective cohort study, researchers examined data for 1,413,655 adult Medicare beneficiaries with ESKD. Data were derived from Medicare Standard Analytic Files between 2013 and 2020.
Researchers balanced cohorts based on age, sex, race, follow-up duration and Charlson Comorbidity Index using propensity-score matching. Cohorts consisted of 21,384 adults with ESKD (of whom 10,692 patients also had IDD) and 1,258 kidney transplant recipients (of whom 629 patients also had IDD).
With IDD serving as the exposures, researchers considered the evaluation by a transplant surgeon, recipient of kidney transplant and postoperative outcomes as primary outcomes of the study. Using multivariable logistic regression models, researchers determined whether patients with IDD experience different postoperative results than those without IDD. Researchers also performed models to see if patients with ESKD receive transplants at different rates based on if they have IDD.
Among the patients with ESKD, 5.9% had IDD and received a kidney transplant compared to 12.8% of patients with ESKD but without IDD. Researchers observed a 54% less likelihood that adults with IDD would be evaluated for a transplant than matched peers without IDD.
However, the matched cohorts of kidney transplant recipients experienced similar rates of perioperative complications, readmissions and graft failure.
“Like peers without IDD, some adults with IDD may not be strong candidates for transplant. However, adults with IDD deserve (and legally have a right to) equal access to evaluation and full holistic consideration as to whether they would be good transplant candidates,” Hand and colleagues Our findings show that adults with IDD were significantly less likely to be evaluated for or receive kidney transplants than propensity score–matched peers without IDD. Using the largest US cohort of adult transplant recipients with IDD to date, we found that perioperative, 90-day, and 1-year kidney transplant outcomes were similar for adults with and without IDD. Ultimately, these results support kidney transplant among adults with IDD and underscore the urgent need for antidiscrimination initiatives to promote the receipt of equitable care for this population.”
Reference:
Ohio State study finds adults with developmental disabilities face disparities in kidney transplantation. https://sc10-wexnermedical.osu.edu/mediaroom/pressreleaselisting/kidney-transplant-idd-disparities. Published Feb. 15, 2023. Accessed Feb. 16, 2023.
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