Psychosocial assessment of organ transplant candidates and the Americans with disabilities act☆

Abstract 

The use of psychosocial criteria to assess candidates for organ transplantation may violate the Americans with Disabilities Act (ADA). The ADA prohibits discrimination on the basis of disability or on the basis of eligibility criteria that disproportionately affect persons with disabilities. When organ programs deny access to a person because of schizophrenia, they are denying an organ on the basis of disability. When organ programs deny access to a noncompliant person, they are denying an organ on the basis of an eligibility criterion that is more common in persons with coexisting disabilities like mental illness. Accordingly, both of these denials may violate the ADA. However, the ADA recognizes that it often is appropriate to take a person's disability into account when allocating organs for transplantation. There is a legitimate social interest in allocating organs in a way that maximizes medical benefit, and a person's disability may compromise the benefit that the person will receive from a transplant. It is likely that courts will interpret the ADA to permit denials of organs or lower waiting list priorities for persons with disabilities as long as predictions of diminished benefit are based on scientifically valid criteria, the assessment of candidates is individualized and not based entirely on generalized predictors, and the transplant program undertakes reasonable steps like psychological counseling to compensate for an organ candidate's coexisting disability.

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