Exclusion from Organ Transplant on the Basis of Ability

Abstract

The availability of organs for transplant is a persisting issue in the field of medicine. As transplant centers have autonomy over selection criteria for transplant, intellectual and developmental disability (IDD) is a consideration among many programs in the process of choosing transplant candidates. Although medical and legal protections, afforded by the Americans with Disabilities Act, are in place to protect against exclusion of patients with IDD, IDD is considered as a contraindication to transplant, marginalizing this patient population. Arguments in favor of considering IDD in organ transplant decisions include the potential utility of allocating organs away from individuals with IDD, a diminished quality of life for those with IDD compared to those without, as well as concerns of nonadherence in post-transplant care of the patient. Nevertheless, I will present the argument that these potential benefits of using IDD as medical criterion in transplant decisions are based in ableism and implicit biases concerning patients with IDD. Therefore, with justice and respect for persons at the forefront of organ allocation, intellectual and/or developmental disability should not contribute to a decision of organ transplant eligibility. Amidst high-stakes allocation considerations based on a shortage of organs, prioritizing just allocation through inclusive and ethically defensible policy must be at the forefront of medical decision-making.