Nasrien E. Ibrahim, MD is an Advanced Heart Failure and Transplant Cardiologist. She is interested in advancing health equity and alleviating the effects of structural racism in organ allocation. In 2021, Dr. Ibrahim was invited by the White House Office of Public Engagement to participate in the Leaders in Health Equity Roundtable Series. She serves on the Dean's Advisory Board for the University of Cincinnati, McMicken College of Arts and Sciences and is the Founder and Director of The Equity in Heart Transplant Project™, a nonprofit that provides need-based financial assistance to patients with end-stage heart failure undergoing a heart transplant. Dr. Ibrahim received her medical degree in 2008, and completed her residency in internal medicine in 2011, and a cardiology fellowship in 2014, all at the University of Cincinnati College of Medicine. Dr. Ibrahim also completed fellowships at the University of Colorado and Massachusetts General Hospital/Harvard Medical School in 2015 and 2017, respectively.
Nasrien E. Ibrahim, MD, MPH
Assistant Professor of Medicine, Harvard Medical School; Advanced Heart Failure and Transplant Cardiologist, Brigham and Women’s Hospital, Boston, MA
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The Role of Hospital Policies in Promoting Equity in Organ Transplantation
Objectives:
- To review institutional living organ donor and organ recipient policies that determine eligibility criteria with a health equity lens
- To recommend changes in institutional transplant policies that would ensure inclusivity and more equitable allocation of organs
Background: Racial and ethnic minority patient populations receive less transplants than White patients, even when the disease burden is higher. For example, Black individuals are four times as likely to develop kidney failure as White individuals, but much less likely to receive a lifesaving kidney transplant.
Determining eligibility for transplant is a complicated process, whereby emotions, ethics, biases, and facts play competing roles. Transplant eligibility consists of 3 sets of prerequisites: medical, financial, and social. Inequities in transplant extend beyond the individual. They exist in a larger context of structural and institutional racism and social determinants of health.
To reduce and eventually eliminate these inequities, policies at federal, state, and institutional levels that contribute to them must be addressed. For example, Medicaid in the State of Georgia does not cover heart transplant for anyone 21 years or older; leaving patients who often have worse outcomes from heart failure with inferior access to lifesaving therapies.
The purpose of this study was to examine institutional organ transplant policies that determine eligibility criteria for both organ donors and organ recipients and make recommendations for how policies can be improved to promote inclusivity and equity in organ allocation.
Methods:
- The University of Iowa Health Care’s Joint Office for Compliance flagged organ transplant policies that needed to be reviewed.
- Eight policies on organ donor and organ recipient eligibility criteria were reviewed. A literature search was performed for items flagged by the attorneys as well as items I noted during my policy review.
- I reconvened with members of the Joint Office for Compliance and my preceptor and shared my findings and recommendations on how policies can be changed to promote inclusivity and equity in organ allocation.
Results: The hospital system has adopted the changes to one policy so far. The changes were centered on the use of more gender inclusive language and on including transgender individuals in cancer screening guidelines for both organ donors and organ recipients. Changes were made recommending against use of racialized genetic testing to exclude organ donors, using body mass index alone as a measure of overall health, and considering psychosocial barriers are relative and not absolute contraindications.
Future Directions:
- Meet with various directors of transplant to discuss adoption of changes recommended to the remaining policies.
- Convene a group of transplant clinicians, social workers, and other members of transplant disciplinary teams to write a statement on the importance of institutional policies in promoting equity in organ allocation and recommended steps to act.
Preceptor: Nicole Del Castillo, MD, MPH- Director of the Office of Diversity, Equity, and Inclusion at CCOM and Clinical Assistant Professor in the Department of Psychiatry, University of Iowa Health Care.
