WEBB FELLOW: Through the Lens of Our Patients – Disparities in Organ Transplant

‎Background/Significance: ‎
Liver transplantation remains the only definitive treatment for end-stage liver disease and liver failure. ‎The current system for organ allocation is designed to maximize fairness and equitable distribution ‎across patient populations (Jesse, 2019). However, studies have reflected continued racial and ethnic ‎disparities at various stages of the liver transplant process, including referral for evaluation, candidacy ‎for listing, and transplant outcomes (Strauss, 2022). Ongoing research into the roots of such disparities ‎understandably focus on systemic factors such as social determinants of health and structural racism, ‎though the perspectives of individuals can yield meaningful insight as well. To date, there has been a ‎paucity of ethnographic research that centers on individual patients’ experiences in navigating and ‎progressing through the liver transplant process. ‎

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Methods: ‎
We are conducting qualitative, ethnographic research into individual patients’ perspectives and ‎stories, as they navigate and advance through the liver transplant process. Patients are recruited from ‎a transplant center in Northeastern United States, with an inclusion criterion that emphasizes diversity ‎in key factors such as ethnic/racial/cultural backgrounds, socioeconomic backgrounds, psychiatric co-‎morbidities, and stages of progress with liver transplant. Patients with white/Caucasian background ‎are matched for socioeconomic and disease factors and served as the control group. Semi-structured, ‎autobiographical patient interviews will be conducted by nontransplant team members, and the ‎resulting data will be studied using thematic analysis with both inductive and deductive approaches.‎

‎Results/Discussion:‎
Data collection for our study is ongoing. Through the stories that our patients share with us, our study ‎will provide unique perspectives into the disparity issues within liver transplantation. Insight into ‎patient-level experiences through the demands and rigors of the transplant evaluation process may ‎provide practical and actionable feedback, as well as avenues for further exploration and research.‎

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Conclusion: ‎
There are very few medical subspecialties that capture the doctor-patient power differential better ‎than organ transplantation. Consultation-liaison and transplant psychiatrists are well-positioned to ‎become advocates for positive change. By leveraging our understanding of individual and systemic ‎drivers of disparities, we can contribute to a more equitable future for our patients. ‎

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References: ‎
Jesse, M. T., Abouljoud, M., Goldstein, E. D., Rebhan, N., Ho, C. X., Macaulay, T., Bebanic, M., ‎Shkokani, L., Moonka, D., & Yoshida, A. (2019). Racial disparities in patient selection for liver ‎transplantation: An ongoing challenge. Clinical transplantation, 33(11), e13714. ‎https://doi.org/10.1111/ctr.13714‎

Strauss, A. T., Sidoti, C. N., Purnell, T. S., Sung, H. C., Jackson, J. W., Levin, S., Jain, V. S., Malinsky, D., ‎Segev, D. L., Hamilton, J. P., Garonzik-Wang, J., Gray, S. H., Levan, M. L., Scalea, J. R., Cameron, A. M., ‎Gurakar, A., & Gurses, A. P. (2022). Multicenter study of racial and ethnic inequities in liver ‎transplantation evaluation: Understanding mechanisms and identifying solutions. Liver ‎transplantation: official publication of the American Association for the Study of Liver Diseases and the ‎International Liver Transplantation Society, 28(12), 1841–1856. https://doi.org/10.1002/lt.26532‎