Barriers to organ transplantation in patients with disabilities: A narrative review

Significant barriers and biases within medical systems hinder equitable access to organ transplantation for patients with disabilities, whether they be intellectual, developmental, or physical. Physicians may hold implicit biases, and transplant centers typically lack disability-specific evaluation standards, which leads to inconsistencies and subjective decisions regarding care. Prior literature has shown that patients with disabilities are less likely to be evaluated for transplant, even with clinical guidelines indicating that appropriate social support should be the driving factor for waitlisting decisions in this population. Commonly cited concerns about poorer outcomes, quality of life, and non-adherence to postoperative care are largely not supported by available evidence, albeit limited. This review will examine factors affecting access to transplantation for patients with disabilities, including guidelines, systemic barriers, implicit biases, and the evidence for patient selection. Additionally, it will discuss standardized functional assessment as a possible path to more equitable evaluation.