(194) Equity in Practice: How to be an Anti-racist Transplant Psychiatrist

Abstract:

Background: Transplant psychiatry and organ selection committees have a past littered with inequalities. With the growing medical advances in transplantation and the increasing number of transplants, it is the perfect time for transplant psychiatrists to adopt anti-racist practices and promote equity in marginalized communities.

Methods:

Search query on PubMed:

“Transplant Racism” Last 10 years

Results: 42 articles, 25 after exclusion of articles not focused on transplant racism

Reviewed the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), Psychosocial Assessment of Candidates for Transplant (PACT), and the Transplant Evaluation Rating Scale (TERS).

Results: Our literature review showed many barriers that would serve to limit or diminish the candidacy for transplantation among minority groups. Specific examples include lack of healthcare, lack of cultural and linguistic aides, and racism serving as a barrier to medical care (Purnell, 2021).

All three rating scales have domains referencing substance use, social support systems, and transplant literacy. (Maldonado, 2008; Olbrisch, et al. 1988; Twillman, et al., 1993).

Discussion:

Our results are consistent that there is inherent inequity in the current transplantation evaluation process. This marginalization is a result of ongoing systemic barriers and differing rates of health literacy, cohesion of social supports, and cultural differences towards nicotine and marijuana.

Conclusions:

We recommend using a holistic and flexible approach in transplant evaluations, with a focus on equity, by advocating for patients in the following ways:

Education of primary care and specialist providers that practice mostly within marginalized communities

Advocating for increased health literacy and outreach in marginalized communities

Adopting a more nuanced approach in applying the social support system, substance use, health literacy, and lifestyle factors of the transplant rating scales.

Less stringent application to absolute and relative contraindications in transplant rating scales, especially concerning drug use, social supports, housing, and health literacy

Advocate for abolishing eGFR race corrections

Promoting services to help process the effects of racism and promote increased treatment alliance

References:

Purnell TS, Simpson DC, Callender CO, Boulware LE. Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation. Am J Transplant. 2021;21:2327–2332. https://doi.org/10.1111/ajt.16543

Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) Stanford University Medical Center. Maldonado et al, 2008; Maldonado et al, Psychosomatics 2012

Olbrisch, M. E., Levenson, J. L., & Hamer, R. (1989). The PACT: A rating scale for the study of clinical decision-making in psychosocial screening of organ transplant candidates. Clinical Transplantation, 3, 164–169.

Twillman, R. K., Manetto, C., Wellisch, D. K., & Wolcott, D. L. (1993). The Transplant Evaluation Rating Scale: A revision of the Psychosocial Levels System for evaluating organ transplant candidates. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 34(2), 144–153. https://doi.org/10.1016/S0033-3182(93)71905-2

Presenting Author(s)

Jordan L. Schwartzberg, DO (he/him/his)

Fellow - Consultation-Liaison Psychiatry
Icahn School of Medicine at Mount Sinai
Long Island City, NY, United States

Co-Author(s)

Storm Portner, MD

Psychiatry Resident
Mount Sinai Hospital
New York, New York, United States

Shruti P. Mutalik, MD

Transplant and Consultation Liaison Psychiatrist
Icahn School of Medicine at Mount Sinai
Woodside, New York, United States

Jacob M. Appel, MD JD

Associate Professor of Psychiatry and Medical Education
Icahn School of Medicine at Mount Sinai
New York, New York, United States