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How important is social support in determining patients’ suitability for transplantation? Results from a National Survey of Transplant Clinicians
  1. Keren Ladin1,2,
  2. Joanna Emerson2,
  3. Zeeshan Butt3,
  4. Elisa J Gordon3,
  5. Douglas W Hanto4,
  6. Jennifer Perloff5,
  7. Norman Daniels6,
  8. Tara A Lavelle7
  1. 1 Departments of Occupational Therapy and Community, Tufts University, Medford, Massachusetts, USA
  2. 2 Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, Massachusetts, USA
  3. 3 Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4 Department of Surgery, Vanderbilt Transplant Center, Vanderbilt University Medical Center, Boston, Massachusetts, USA
  5. 5 Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
  6. 6 Department of Global Health and Population, Harvard Chan School of Public Health, Boston, Massachusetts, USA
  7. 7 Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Professor Keren Ladin, Departments of Occupational Therapy and Community Health, Tufts University, Medford, MA 02155, USA; Keren.Ladin{at}


Background National guidelines require programmes use subjective assessments of social support when determining transplant suitability, despite limited evidence linking it to outcomes. We examined how transplant providers weigh the importance of social support for kidney transplantation compared with other factors, and variation by clinical role and personal beliefs.

Methods The National survey of the American Society of Transplant Surgeons and the Society of Transplant Social Work in 2016. Using a discrete choice approach, respondents compared two hypothetical patient profiles and selected one for transplantation. Conditional logistic regression estimated the relative importance of each factor; results were stratified by clinical role (psychosocial vs medical/surgical providers) and beliefs (outcomes vs equity).

Results Five hundred and eighy-four transplant providers completed the survey. Social support was the second most influential factor among transplant providers. Providers were most likely to choose a candidate who had social support (OR=1.68, 95% CI 1.50 to 1.86), always adhered to a medical regimen (OR=1.64, 95% CI 1.46 to 1.88), and had a 15 years life expectancy with transplant (OR=1.61, 95% CI 1.42 to 1.85). Psychosocial providers were more influenced by adherence and quality of life compared with medical/surgical providers, who were more influenced by candidates' life expectancy with transplant (p<0.05). For providers concerned with avoiding organ waste, social support was the most influential factor, while it was the least influential for clinicians concerned with fairness (p<0.05).

Conclusions Social support is highly influential in listing decisions and may exacerbate transplant disparities. Providers’ beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice.

  • allocation of organs/tissues
  • decision-making
  • surgery
  • social work
  • social aspects

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  • Twitter Please follow Keren Ladin @KerenLadin

  • Contributors KL conceived of the study and oversaw all aspects including writing. TAL oversaw the study design and statistical analysis and contributed to manuscript writing, JP and JE contributed to the study design and analysis; DWH contributed to data acquisition and to key elements of study design, EJG, ZB, ND contributed to the design of the experiment and to the manuscript development.

  • Funding Financial support for this study was provided by the Greenwall Foundation through their “Making a Difference” grants. KL also received funding support from the Greenwall Faculty Scholars program from the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number KL2TR001063. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Tufts University Institutional Review Board in January 2016.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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