Clinical Scorecard: Disability Antidiscrimination Laws and Kidney Transplant Access for Patients With Developmental Disabilities
At a Glance
Category
Detail
Condition
Clinical topic addressed by the source article: Disability Antidiscrimination Laws and Kidney Transplant Access for Patients With Developmental Disabilities
Key Mechanisms
The study assessed whether state disability antidiscrimination laws, including expedited case review and a private right of action, were associated with disparities in kidney transplant evaluation and receipt rates.
Target Population
Population described in the source article.
Care Setting
Care setting described in the source article.
Key Highlights
The matched cohorts included 12,730 patients with IDD and 49,199 controls.
Compared with controls, patients with IDD had lower rates of transplant evaluation (IRR, 0.78; 95% CI, 0.75-0.81) and transplant receipt (IRR, 0.62; 95% CI, 0.57-0.66).
Passage of any state antidiscrimination law was not significantly associated with disparities in evaluation or transplant receipt.
Within the IDD group, rates did not differ significantly according to whether laws included expedited review and/or a private right of action.
The authors identify limitations including lack of measures of transplant appropriateness and social support, and inability to determine whether some patients chose not to pursue evaluation or transplantation.
Guideline-Based Recommendations
Diagnosis
Management
The authors call for advocacy to strengthen antidiscrimination legislation, reduce implicit clinician bias, and require transparency in transplant center decision-making.
The authors call for holistic eligibility evaluations that do not apply IDD-specific contraindications or incorporate bias.
The authors describe electronic health record registries to identify eligible candidates and automatically refer them for evaluation, and patient or advocate participation in transplant committee deliberations, as proposed approaches.
Monitoring & Follow-up
The authors state that data registries are needed to track candidates’ progress through the transplant care pathway according to social determinants of health.
Risks
The study reports lower transplant evaluation and receipt rates among patients with IDD than among matched controls.
The authors note that discriminatory treatment may be difficult to recognize and substantiate, and that awareness of legal protections and avenues for contesting possible discrimination may vary.
Patient & Prescribing Data
Medicare patients with ESKD in the United States; matched cohorts included 12,730 patients with IDD and 49,199 patients without IDD.
The article evaluates access to kidney transplant evaluation and receipt, not medication prescribing. Patients with IDD had lower rates of both outcomes than matched controls.
Clinical Best Practices
The authors call for holistic transplant eligibility evaluations that avoid IDD-specific contraindications and bias.
The authors propose electronic health record registries to identify eligible candidates and automate referral for evaluation.
The authors describe patient or advocate participation in transplant committee deliberations as a proposed approach.
The authors state that data registries are needed to track candidates’ movement through transplant care pathways according to social determinants of health.
by Brittany N. Hand, J. Madison Hyer, Melica Nikahd, Andrew Gothard, Guy Brock, John Gardner, Lauren Bishop, Lindsay Shea, Lauren Wang, Austin D. Schenk
