Racial disparities across multiple stages of the deceased organ donation process

Area of Science:

• Organ transplantation research
• Health equity studies
• Public health policy analysis

Background:

• Structural violence contributes to higher organ failure rates in Black Americans.
• Underutilization of Black donors exacerbates organ shortages, disproportionately affecting Black transplant candidates.
• Significant racial disparities exist in organ donation pathways.

Purpose of the Study:

• To investigate racial differences in organ donation transitions.
• To quantify disparities in organ utilization rates across racial groups.
• To estimate the impact of donor conversion disparities on organ availability.

Main Methods:

• Multilevel multistate modeling of 132,968 potential donors (2015-2021).
• Analysis of transitions between donation steps: OPO referral, approach, authorization, procurement, and transplant.
• Multilevel logistic regression to estimate organ utilization odds ratios by race, controlling for covariates and OPO/hospital effects.

Main Results:

• Non-Black patients had higher odds of transitioning through key donation steps compared to Black patients.
• Organ utilization rates were 5.88% for Black, 8.17% for Latino, 6.78% for White, and 5.24% for other referrals.
• Adjusted models showed significantly higher odds of organ utilization for Latino, White, and other patients compared to Black patients.
• Donor conversion disparities likely resulted in over 1800 lost donors in 2022, with 70% being Black.

Conclusions:

• Racial disparities persist throughout the organ donation process, from referral to utilization.
• These disparities contribute to the organ shortage crisis for Black transplant candidates.
• Achieving racial equity in transplantation necessitates targeted interventions to reduce disparities in organ donation.