Differences in Donor Heart Acceptance by Race and Gender of Patients on the Transplant Waiting List

Area of Science:

• Cardiology
• Transplantation
• Health Disparities

Background:

• Barriers to heart transplantation exist, and racial disparities in receiving transplants after listing are not fully understood.
• Black men and women are less likely to receive a heart transplant compared to White men and women.

Purpose of the Study:

• To determine if the race or gender of heart transplant candidates influences donor heart acceptance by transplant centers.
• To analyze the association between candidate race/gender and the probability of organ acceptance per offer.

Main Methods:

• A cohort study utilizing United Network for Organ Sharing data from October 2018 to March 2023.
• Analysis included US non-Hispanic Black and White adults listed for heart transplant.
• Discrete time-to-event analyses and generalized linear mixed models assessed offer acceptance, adjusting for candidate, donor, and offer variables.

Main Results:

• Cumulative incidence of heart offer acceptance was lower for Black candidates than White candidates across genders.
• Acceptance rates were higher for women than men for initial offers but lower for later offers.
• Odds of acceptance were significantly lower for Black candidates (OR, 0.76) and higher for women (OR, 1.53) for early offers.

Conclusions:

• Heart offer acceptance rates are consistently lower for Black candidates and higher for women compared to their counterparts.
• These disparities persist even after adjusting for key variables, indicating potential racial and gender bias in decision-making.
• Further research into site-specific decision-making processes is needed to promote equitable donor heart acceptance.