Inequitable Access to Transplants: Adults With Impaired Decision-Making Capacity

Rebecca L. Thom*, Anne Dalle-Ave, Eline M. Bunnik, Tanja Krones, Kristof Van Assche, Alex Ruck Keene, Antonia J. Cronin

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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Inequitable access to deceased donor organs for transplantation has received considerable scrutiny in recent years. Emerging evidence suggests patients with impaired decision-making capacity (IDC) face inequitable access to transplantation. The “Ethical and Legal Issues” working group of the European Society of Transplantation undertook an expert consensus process. Literature relating to transplantation in patients with IDC was examined and collated to investigate whether IDC is associated with inferior transplant outcomes and the legitimacy of this healthcare inequality was examined. Even though the available evidence of inferior transplant outcomes in these patients is limited, the working group concluded that access to transplantation in patients with IDC may be inequitable. Consequently, we argue that IDC should not in and of itself be considered as a barrier to either registration on the transplant waiting list or allocation of an organ. Strategies for non-discrimination should focus on ensuring eligibility is based upon sound evidence and outcomes without reference to non-medical criteria. Recommendations to support policy makers and healthcare providers to reduce unintended inequity and inadvertent discrimination are set out. We call upon transplant centres and national bodies to include data on decision-making capacity in routine reporting schedules in order to improve the evidence base upon which organ policy decisions are made going forward.

Original languageEnglish
Article number10084
JournalTransplant International
Publication statusPublished - 18 Mar 2022

Bibliographical note

We thank the European Society for Organ Transplantation for facilitating the consensus process.

Publisher Copyright:
Copyright © 2022 Thom, Dalle-Ave, Bunnik, Krones, Van Assche, Ruck Keene and Cronin.


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