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. Method(s) 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). Result(s) 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(s) 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. Conclusion(s) We recommend using a holistic and flexible approach in transplant evaluations, with a focus on equity, by advocating for patients in the following ways 1. Education of primary care and specialist providers that practice mostly within marginalized communities 2. Advocating for increased health literacy and outreach in marginalized communities 3. Adopting a more nuanced approach in applying the social support system, substance use, health literacy, and lifestyle factors of the transplant rating scales. 4. Less stringent application to absolute and relative contraindications in transplant rating scales, especially concerning drug use, social supports, housing, and health literacy 5. Advocate for abolishing eGFR race corrections 6. Promoting services to help process the effects of racism and promote increased treatment alliance References 1. 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;212327-2332. 2. Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) Stanford University Medical Center. Maldonado et al, 2008;Maldonado et al, Psychosomatics 2012 3. 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. 4. 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. Copyright © 2022