Opinion Review
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Processing time: 157 Days and 9.2 Hours
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.

Keywords: End-stage renal disease; Compliance; Labeling; Social determinants

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.