PSYCHOSOCIAL ASSESSMENT OF ORGAN TRANSPLANT CANDIDATES AND THE AMERICANS-WITH-DISABILITIES-ACT

The use of psychosocial criteria to assess candidates for organ transp lantation may violate the Americans with Disabilities Act (ADA). The A DA prohibits discrimination on the basis of disability or on the basis of eligibility criteria that disproportionately affect persons with d isabilities. When organ programs deny access to a person because of sc hizophrenia, 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. Accordin gly, both of these denials may violate the ADA. However, the ADA recog nizes that it often is appropriate to take a person's disability into account when allocating organs for transplantation. There is a legitim ate social interest in allocating organs in a way that maximizes medic al benefit, and a person's disability may compromise the benefit that the person will receive from a transplant. It is likely that courts wi ll interpret the ADA to permit denials of organs or lower waiting list priorities for persons with disabilities as long as predictions of di minished benefit are based an scientifically valid criteria, the asses sment of candidates is individualized and not based entirely on genera lized predictors, and the transplant program undertakes reasonable ste ps like psychological counseling to compensate for an organ candidate' s coexisting disability. (C) 1996 Elsevier Science Inc.