Transplant community has options to help eliminate bias from evaluation, selection process
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SCOTTSDALE, Ariz. — Transparency and collaboration are key in helping kidney specialists improve processes for selection of patients for transplantation, according to a presenter at the Cutting Edge of Transplantation Summit.
“We can’t fix all the disparities that we encounter,” Joel T. Adler, MD, MPH, said in the presentation. “A lot of things happen before we get to see patients in the transplant center.
“I would submit, and I think we can all generally agree, that we do a lot to get in our own way in the evaluation and selection process and we worsen disparities in gaining access to a transplant. We can make that better.”
Adler, an assistant professor of surgery in the department of perioperative care in the division of abdominal transplantation at the University of Texas at Austin, said the issues of race and ethnicity are common themes through the evaluation process. “We know that we see waitlisting times that are longer [for a transplant], and [historically underrepresented groups] patients get on the list less frequently,” Adler said.
Adler said he and many of his fellow surgeons know about disparities in the selection process of patients, “but what we have is less data on the improvement process, that quality metric piece,” Adler said. “How do we get to that so we can not only be accountable to ourselves but to our patients, to our community and to everyone else?”
Testing
Adler questioned the sometimes rigorous approach to evaluating patients for transplant. “These patients are very sick,” he told conference attendees. “Completion of the evaluation from their perspective is hard. There is a lot to do; there are a lot of appointments.
“We know from the data that we have that this is easier to get through for people who are at a higher socioeconomic status,” Adler said.
The requirements for the evaluation process could be streamlined. “I would submit that we do a lot of things that may or may not be necessary,” Adler said. “We do a lot of testing. Some of it may be of low value at the end of the day.”
Geography
Geographic variation also plays a role in whether patients get evaluated for transplant, Adler said. Telehealth is helpful, but more needs to be done. “The variability in geography is also another way to characterize the variability in a [transplant] center practice,” he said.
“As a program, we cannot fix all the disparities ... it’s not that the process we have or the choices that we make don’t have good intentions in evaluating patients for transplant,” Adler said. “But we can always be transparent in recognizing what we do about these processes and what we can do differently.
“I think the data is there to answer a lot of these questions.”
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Adler JT. Inadequacies in transplant evaluation and selection. Presented at: Cutting Edge of Transplantation Summit. Feb. 23-25, 2023; Scottsdale, Ariz.
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