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Published on: June 23, 2014
Racial and ethnic disparities on the heart transplant waiting list
Ahad Firoz1, Daniel Remer2, Huaqing Zhao3
1Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, United States of America.
Insights
Racial disparities persist in heart transplantation (HTx) waitlist outcomes. Black and Hispanic patients face lower odds of receiving a transplant, though waitlist mortality for Black patients has decreased recently.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Equity
Background:
- Racial disparities significantly impact heart transplantation (HTx) in the US.
- While post-transplant survival inequities are studied, waitlist outcomes data are limited and conflicting.
- This study analyzes mortality and transplantation rates on the heart transplant waiting list across racial and ethnic groups.
Purpose of the Study:
- To investigate racial and ethnic disparities in heart transplant (HTx) waitlist mortality.
- To analyze racial and ethnic disparities in the odds of receiving a heart transplant (HTx).
- To assess trends in HTx waitlist outcomes over time and after policy changes.
Main Methods:
- Analysis of adult patients listed for heart transplantation (HTx) from 1/2000-9/2023 using the UNOS database.
- Inclusion criteria focused on patients identifying as White, Black, Hispanic, or Asian.
- Exclusion of patients with prior HTx, concurrent lung listings, heterotopic, or multi-organ transplants. Waitlist mortality and transplantation odds were analyzed.
Main Results:
- The proportion of Black and Hispanic patients on the HTx waitlist increased; Asian proportions remained stable, and White proportions decreased.
- Black patients exhibited higher waitlist mortality in the early 21st century, a risk that became negligible in the last decade.
- Black and Hispanic patients consistently had significantly lower odds of transplantation, persisting even after the new allocation policy implementation.
Conclusions:
- Significant disparities persist for Black and Hispanic patients in the heart transplant (HTx) listing process.
- Addressing bias awareness, increasing diversity in evaluation teams, and tackling social determinants of health are crucial for improving outcomes.
- Continued efforts are needed to ensure equitable access to heart transplantation (HTx) for all racial and ethnic groups.
Background:
Racial disparities continue to affect countless individuals across the United States and is an ongoing issue in heart transplantation (HTx). Though inequities for post-transplant survival have been studied, there remains limited and conflicting data for waitlist outcomes. Our investigation aims to address this by analyzing mortality and transplantation outcomes on the heart transplant waiting list for various racial and ethnic groups.
Methods:
We analyzed adult patients listed for HTx between 1/2000-9/2023 using the UNOS database. Inclusion criteria included patients who identified as "White", "Black", "Hispanic", or "Asian". Patients with a prior HTx, those listed concurrently for heart-lung or lung transplants, and recipients who ultimately received a heterotopic HTx or multi-organ transplant, were excluded. Outcomes that were analyzed include waitlist mortality and odds of transplantation.
Results:
Over the course of the study period, the proportion of Black and Hispanic patients listed for HTx increased, while Asian groups remained stagnant and White individuals decreased. In the 21st century, we found that Black patients had increased mortality on the waitlist, however, this risk became negligible in the past decade. Odds of transplantation were significantly lower for Black and Hispanic patients, which persisted today even after implementation of the new allocation policy.
Conclusion:
Disparities continue to exist for minority groups, namely Black and Hispanic patients, in the listing process for a heart transplant. Outcomes for marginalized populations may be improved through continued training in bias awareness, increased diversity in the HTx evaluation team, and strengthened societal efforts to address social determinants of health.
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