Background: Although the Centers for Medicare and Medicaid Services require that social support be used to determine transplant eligibility, guidance is vague. Centers vary significantly in their use of social support, with some categorically excluding patients due to inadequate support and others seldom doing so. These practices are poorly understood. We examine how often patients are excluded due to social support, and how transplant clinicians perceive the legitimacy of using social support.

Methods: We surveyed memberships of the American Society of Transplant Surgeons and Society of Transplant Social Workers in September 2016. Questions examined attitudes about and confidence in using social support, perceived benefit, and potential implications for justice. Nonparametric tests and logistic regression were conducted.

Results: This national sample included 605 transplant clinicians (response rate=32%). While 86% of respondents agreed that patients with inadequate support are less likely to be listed, only 65% agreed this should be the case. Nearly half of respondents were only somewhat or not at all confident in using social support to determine transplant eligibility, while a quarter thought using social support to determine eligibility was unfair. Across centers, on average 10% (std dev 9.2) of candidates were excluded due to inadequate support; 67.7% felt that this disproportionately impacted patients with low socioeconomic status. In multivariate regression models, respondents who thought that social support prevents organ waste (OR=2.21 CI 1.67 2.91) and is fair (OR=3.18 CI 2.34 4.33) were more likely to support its use. Respondents differed in their primary reason for assessing social support. Concerns included: transportation, adherence, quality of life, and instrumental value.

Conclusions: Centers vary significantly in their use of social support, with some centers excluding more than 20% of patients due to social support. Clinicians are divided over the legitimacy, with concerns stemming from disproportionate impact on vulnerable populations. Future studies should examine interventions supplementing social support to address concerns about transportation and adherence, which in some states is achieved through Medicaid-funded services.

CITATION INFORMATION: Ladin K, Gordon E, Butt Z, Lavelle T, Daniels N, Hanto D. Perceived Legitimacy of Using Social Support for Transplant Eligibility: Results from a National Survey of Transplant Clinicians. Am J Transplant. 2017;17 (suppl 3).

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