September 21, 2026
Key Takeaways
- State anti-discrimination laws have not closed the kidney transplant gap for patients with intellectual and developmental disabilities, Ohio State College of Medicine researchers found.
- Medicare data show patients with IDD were 22% less likely to be assessed for a transplant and 38% less likely to receive one than patients without IDD.
- Researchers say stronger oversight, more transparency and better data tracking are needed to reduce bias in transplant decisions.
COLUMBUS, Ohio – State laws to combat disability-based discrimination in the organ transplant process aren’t working, according to new research from The Ohio State University College of Medicine.
The study, published in JAMA Internal Medicine, examines national policies designed to help all patients have a fair chance to receive an organ transplant. Despite 40 states passing laws prohibiting disability-based discrimination in the organ transplant process, people with intellectual and/or developmental disabilities (IDD) are still less likely to receive a kidney transplant compared to those without IDD.
“These findings show how difficult it can be for legal protections to lead to real changes in patient care,” said Brittany Hand, PhD, lead author and associate professor in the Department of Internal Medicine. “Because transplant eligibility decisions involve complex clinical and psychosocial evaluations, discrimination can be difficult to recognize and document.”
Researchers analyzed Medicare Standard Analytical Files from 2013 – 2023 to identify end stage kidney disease patients with and without IDD. Medicare insures qualifying Americans on dialysis and kidney transplant recipients of any age.
The data reveals patients with IDD were evaluated for a transplant 22% less often and received a transplant 38% less often. The study found no evidence that these laws reduced differences in transplant evaluations or transplant rates.
“Legislation alone may not be enough to reduce these differences without complementary efforts to improve transparency and oversight of the entire transplant process,” said Austin Schenk, MD, PhD, transplant surgeon and clinical associate professor in the Department of Surgery.
The research team proposed strategies to mitigate disparities:
- Use electronic health records to identify eligible patients and automatically refer them transplant assessment to reduce physician biases at the referral stage.
- Improve transparency in the transplant committee selection process by allowing patient or advocate participation.
- Create data registries to follow patients through every step of the transplant process, from referral to evaluation, to deferral or listing to transplantation.
“Future advocacy efforts are needed to strengthen anti-discrimination laws, reduce provider bias and require transparency in transplant center decision-making,” Hand said. “Ensuring equitable access requires that people with IDD are holistically evaluated without IDD-specific contraindications or bias.”
Additional researchers involved in the study include J. Madison Hyer, Melica Nikahd, Andrew Gothard, Guy Brook, PhD, from Ohio State; John Gardner, PhD, from the University of Mississippi; Lauren Bishop, PhD, from the University of Wisconsin-Madison; Lindsay Shea, DrPH, from Drexel University; and Lauren Wang, MD, from the University of Cincinnati.
Media Contact
Serena Smith, Ohio State Wexner Medical Center Media Relations, Serena.Smith@osumc.edu