The Social Support Criterion in Transplantation: Considerations for Distributive and Procedural Justice

To ensure fairness and transparency, standardized evaluation criteria have been established to determine eligibility for transplantation. These include: medical, demographic, and psychosocial factors, including social support. Although evaluation criteria are largely evidence-based, there is weak evidence linking social support and transplant outcomes. Using social support to determine eligibility remains controversial for multiple reasons. First, social support remains the only criterion that uses information about others to determine patient eligibility. Second, there is lack of consensus about definitions, evaluation procedures, and consideration of social support in the listing decision. Third, continued use of the social support criterion may restrict access for vulnerable populations who have more difficulty demonstrating adequate support, may have more strained social support systems, and may be less able to finance home-based assistance. This study examines evaluation practices and interventions related to social support in a national sample of transplant centers. Investigators will survey the transplant community’s attitudes about the legitimacy of the social support criterion and their perception of the importance of social support to transplant outcomes. Using qualitative and quantitative approaches, they will examine whether vulnerable populations are more likely to be scrutinized for inadequate support. The study’s ethical analysis will consider whether the continued use of the social support criterion can be morally defended.