Improving Racial Equity in Clinical Decision Making about Access to Organ Transplant

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PROJECT SUMMARY Organ transplantation is the optimal treatment for end stage organ disease and results in improved patient survival and quality of life. Black patients have rates of end stage organ disease nearly three times that of white patients, yet comprise only 20% of organ transplant recipients. The transplant selection process is not standardized across transplant centers and therefore decision making at each phase of the process is potentially vulnerable to institutional racism. Further, national transplant data collection and monitoring exclude the transplant selection process. The overall objective of this proposal is to identify, characterize, and intervene on inequities in organ transplant that occur due to health system processes which are vulnerable to interpersonal and institutional bias Our central hypothesis is that inadequate attention to equity promoting principles throughout each phase of the selection process are major contributors to inequitable access to organ transplant. This project will quantify racial inequities at each phase of the transplant selection process (screening, evaluation and committee decision making) using electronic health record data, characterize vulnerabilities in the transplant screening, evaluation and committee decision aming processes that contribute to overall inequities in access to transplant and design and pilot a toolkit to reduce inequities in the transplant screening, evaluation and committee decision making processes. This results of this project will elucidate the influence of institutional racism in transplant systems and processes on racial equity in access to transplant. The research and additional knowledge and skill development will form a strong foundation for the candidate’s transition to an independent investigator studying interventions to overcome institutionally biased practices which contribute to organ transplant inequities.