Disqualifying patients with intellectual disabilities (ID) from transplantation has received growing attention from the media, state legislatures, the Office of Civil Rights, and recently the National Council on Disability, as well as internationally. Compared with evidence‐based criteria used to determine transplant eligibility, the ID criterion remains controversial because of its potential to be discriminatory, subjective, and because its relationship to outcomes is uncertain. Use of ID in determining transplant candidacy may stem partly from perceived worse adherence and outcomes for patients with ID, fear of penalties to transplant centers for poor outcomes, and stigma surrounding the quality of life for people with ID. However, using ID as a contraindication to solid organ transplantation is not evidence‐based and reduces equitable access to transplantation, disadvantaging an already vulnerable population. Variability and lack of transparency in referral and evaluation allows for gatekeeping, threatens patient autonomy, limits access to lifesaving treatment, and may be seen as unfair. We examine the benefits and harms of using ID as a transplant eligibility criterion, review current clinical evidence and ethical considerations, and make recommendations for transplant teams and regulatory agencies to ensure fair access to transplant for individuals with ID.

中文翻译：

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智障人士获得移植：非歧视策略。

取消智障 (ID) 患者移植资格的做法越来越受到媒体、州立法机构、民权办公室以及最近的全国残疾人委员会以及国际社会的关注。与用于确定移植资格的循证标准相比，ID 标准仍然存在争议，因为它可能具有歧视性、主观性，并且与结果的关系不确定。在确定移植候选资格时使用 ID 可能部分源于对 ID 患者的依从性和结果较差、担心移植中心因不良结果而受到处罚以及围绕 ID 患者生活质量的耻辱感。然而，将 ID 作为实体器官移植的禁忌症是不以证据为基础的，并且会减少移植的公平机会，使本已脆弱的人群处于不利地位。转诊和评估的可变性和缺乏透明度会导致把关，威胁患者的自主权，限制获得救生治疗的机会，并且可能被视为不公平。我们检查使用 ID 作为移植资格标准的好处和危害，审查当前的临床证据和伦理考虑，并为移植团队和监管机构提出建议，以确保有 ID 的个人公平获得移植。限制获得救生治疗的机会，并且可能被视为不公平。我们检查使用 ID 作为移植资格标准的好处和危害，审查当前的临床证据和伦理考虑，并为移植团队和监管机构提出建议，以确保有 ID 的个人公平获得移植。限制获得救生治疗的机会，并且可能被视为不公平。我们检查使用 ID 作为移植资格标准的好处和危害，审查当前的临床证据和伦理考虑，并为移植团队和监管机构提出建议，以确保有 ID 的个人公平获得移植。