# Impact of ableism and state laws designed to mitigate ableism on organ transplant equity for kidney transplant candidates with intellectual or developmental disabilities

> **NIH NIH R01** · OHIO STATE UNIVERSITY · 2024 · $507,163

## Abstract

PROJECT SUMMARY
Ableist discrimination is pervasive in healthcare and negatively affects the US organ transplant system, resulting
in patients with intellectual or developmental disabilities (IDD) often being unjustly excluded from life-saving
transplantation. To address this inequity, thirty-nine states have passed laws prohibiting disability-based
discrimination in organ transplantation. Currently, we do not know the extent to which anti-discrimination laws
mitigate ableism against patients with IDD, nor do we know which patient factors compound with ableism to
exacerbate disparities in transplantation access. Focusing on kidney transplantation, the most commonly
transplanted solid organ in the US, we will leverage our team’s unique expertise in IDD, transplant equity,
population-level claims data, and policy evaluation to achieve our specific aims: (Aim 1) determine the efficacy
of state laws prohibiting ableist discrimination in closing the equity gap between kidney transplant candidates
with vs. without IDD; (Aim 2) identify patient factors that compound with ableism to disproportionately reduce
kidney transplant access and increase dialysis time for patients with vs. without IDD; (Exploratory Aim 3)
compare reasons for exclusion among patients with vs. without IDD to understand how ableism impacts access
to kidney transplantation. We will achieve these aims through the synergistic use of national Medicare claims
data and local electronic health records (EHR) data. In Aim 1, we will use staggered adoption difference-in-
difference models to assess the impact of anti-discrimination laws on kidney transplant access for propensity
score matched samples of patients with and without IDD. In Aim 2, we will use multi-level regression and time-
to-event models with interaction terms and contrast statements to quantify the compounding effects of
comorbidities and social determinants of health with ableism for patients with IDD relative to propensity-score
matched patients without IDD. Last, in Exploratory Aim 3, we will leverage EHR data from four large academic
transplant centers to compare the stated reasons for kidney transplant denial between patients with and without
IDD. Findings will have practical applications for healthcare providers, regulatory agencies, and legislators
responsible for mitigating ableism against people with IDD in organ transplantation. This study is responsive to
RFA-HD-24-007 in that we will “examine the impact of existing efforts to address ableism (e.g., laws) on the
health of individuals” with IDD and how patient factors mediate the “impacts of ableism on health.” This project
will have a high public health impact yielding new, actionable information to further mitigate ableism against
people with IDD in organ transplantation and improve equitable access to this life-saving care.

## Key facts

- **NIH application ID:** 10992023
- **Project number:** 1R01HD116245-01
- **Recipient organization:** OHIO STATE UNIVERSITY
- **Principal Investigator:** Brittany Nicole Hand
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $507,163
- **Award type:** 1
- **Project period:** 2024-08-01 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10992023

## Citation

> US National Institutes of Health, RePORTER application 10992023, Impact of ableism and state laws designed to mitigate ableism on organ transplant equity for kidney transplant candidates with intellectual or developmental disabilities (1R01HD116245-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10992023. Licensed CC0.

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