Peticca B, Prudencio TM, Robinson SG, Karhadkar SS. Challenges with non-descriptive compliance labeling of end-stage renal disease patients in accessibility for renal transplantation. World J Nephrol 2024; 13(1): 88967 [PMID: 38596267 DOI: 10.5527/wjn.v13.i1.88967]
Corresponding Author of This Article
Sunil S Karhadkar, FACS, MD, Associate Professor, Surgeon, Department of Surgery, Lewis Katz School of Medicine at Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, United States. sunil.karhadkar@tuhs.temple.edu
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Mar 25, 2024; 13(1): 88967 Published online Mar 25, 2024. doi: 10.5527/wjn.v13.i1.88967
Challenges with non-descriptive compliance labeling of end-stage renal disease patients in accessibility for renal transplantation
Benjamin Peticca, Tomas M Prudencio, Samuel G Robinson, Sunil S Karhadkar
Benjamin Peticca, Tomas M Prudencio, Samuel G Robinson, Sunil S Karhadkar, Department of Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, United States
Co-first authors: Benjamin Peticca and Tomas M Prudencio.
Author contributions: Peticca B and Prudencio TM contributed equally to this work; Peticca B, Prudencio TM, and Karhadkar SS designed the research study; Peticca B, Prudencio TM, Robinson SG, and Karhadkar SS participated in drafting the manuscript and critical manuscript revision. Peticca B and Prudencio TM performed data collection and statistical analysis; All authors have read and approved the final manuscript. Benjamin Peticca and Prudencio Tomas M contributed equally to this manuscript.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sunil S Karhadkar, FACS, MD, Associate Professor, Surgeon, Department of Surgery, Lewis Katz School of Medicine at Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, United States. sunil.karhadkar@tuhs.temple.edu
Received: October 16, 2023 Peer-review started: October 16, 2023 First decision: November 14, 2023 Revised: November 22, 2023 Accepted: December 22, 2023 Article in press: December 22, 2023 Published online: March 25, 2024
Abstract
Non-descriptive and convenient labels are uninformative and unfairly project blame onto patients. The language clinicians use in the Electronic Medical Record, research, and clinical settings shapes biases and subsequent behaviors of all providers involved in the enterprise of transplantation. Terminology such as noncompliant and nonadherent serve as a reason for waitlist inactivation and limit access to life-saving transplantation. These labels fail to capture all the circumstances surrounding a patient’s inability to follow their care regimen, trivialize social determinants of health variables, and bring unsubstantiated subjectivity into decisions regarding organ allocation. Furthermore, insufficient Medicare coverage has forced patients to ration or stop taking medication, leading to allograft failure and their subsequent diagnosis of noncompliant. We argue that perpetuating non-descriptive language adds little substantive information, increases subjectivity to the organ allocation process, and plays a major role in reduced access to transplantation. For patients with existing barriers to care, such as racial/ethnic minorities, these effects may be even more drastic. Transplant committees must ensure thorough documentation to correctly encapsulate the entirety of a patient’s position and give voice to an already vulnerable population.
Core Tip: For a very long time, patients with renal failure have had challenges to transplantation. Inequities in access to transplantation are widely apparent across diverse geographic zones. Increasing these disparities are non-descriptive labels that perpetuate stereotypes and further disadvantage minority populations. In this manuscript, we crystallize the roles of such labeling and seek to implore the Nephrology community to improve equity in organ transplantation.
