Pediatric Psychologists as Agents of Change Addressing Liver and Kidney Transplant Waitlisting

Abstract

Objective: Inequities in accessing waitlisting for liver and kidney transplantation among pediatric and adult populations are well-documented, with disparities related to race, ethnicity, and socioeconomic status consistently present in both settings. Historically, studies examining barriers to transplant waitlisting have focused mainly on patient and family demographics. However, due to the complexity and subjectivity of pretransplant evaluations, other factors (e.g., provider biases) likely influence waitlisting decisions. This topical review brings awareness to how provider biases toward race, ethnicity, and socioeconomic status may impact access to pediatric liver and kidney transplant waitlisting. Methods: Searches using keywords such as ethnic and racial minorities, waiting lists, transplantation, poverty, and pediatrics were conducted in https://inPubMed.gov, CINAHL Complete (EBSCO), PsychINFO (EBSCO), https://Embase.com, https://Scopus.com, and Web of Science databases with no relevant findings including provider bias in pediatric liver or kidney transplant. A second search in only PubMed with no limit by age produced four relevant articles between 2004 and 2023. Results: Provider biases within the pretransplantation evaluation and waitlisting processes have been explored in adult populations and are starting to be explored in some pediatric subspecialties, though gaps remain in pediatric liver and kidney transplantation. Conclusions: Pediatric kidney and liver transplant waitlisting may be impacted by provider biases throughout the evaluation process. More research is needed to determine areas of susceptibility and how to reduce bias throughout the subjective processes of transplant evaluation. We provide recommendations for how pediatric psychologists can use their skillsets to decrease bias and advance equity in pediatric liver and kidney transplantation settings.