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From Referral to Consent: Unveiling Racial Disparities at Critical Stages of Pediatric Organ Donation
Mario O'Connor1, Hugo R Martinez1, Maria E Hoyos1
1Texas Center for Pediatric and Congenital Heart Disease, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA.
Insights
Racial disparities persist in pediatric organ donation, with minority groups less likely to be approached for consent. This highlights the need for equitable organ donation processes to increase the pediatric donor pool.
Area of Science:
- Medical research
- Transplantation science
- Public health
Background:
- Organ transplantation is a life-saving treatment for end-stage organ failure.
- Persistent racial and ethnic disparities exist in organ donation.
- The impact of these disparities on pediatric organ donation is not well understood.
Purpose of the Study:
- To investigate racial and ethnic disparities in the pediatric deceased organ donation process.
- To analyze organ donor approach and consent rates across different racial and ethnic groups in pediatric patients.
Main Methods:
- Retrospective review of the Organ Retrieval and Collection of Health Information for Donation (ORCHID) database (2015-2021).
- Inclusion of all referred patients younger than 18 years.
- Statistical analysis of organ donor approach and consent rates adjusted for demographic factors.
Main Results:
- Racial minority groups (Hispanic, Black, Other) were significantly less likely to be approached for organ donation compared to White Non-Hispanic individuals.
- Consent rates for organ donation were also significantly lower among racial minority groups compared to White Non-Hispanic individuals.
- Accidents were the leading cause of death among referred pediatric patients.
Conclusions:
- Significant racial disparities exist in both organ donor approach and consent rates within the pediatric population.
- These disparities contribute to inequities in the organ donation process.
- Developing equitable strategies is crucial to expand the pediatric deceased donor pool and improve access to transplantation.
Background:
Organ transplantation is the gold standard for treating end-stage organ failure, improving survival and quality of life. Despite efforts to address racial and ethnic disparities, these disparities persist, with their impact on the pediatric organ donation process remaining unclear.
Methods:
This is a retrospective review of the Organ Retrieval and Collection of Health Information for Donation (ORCHID) database version 2.0.0, from 01/01/2015 to 12/31/2021. All patients referred younger than 18 years were included.
Results:
A total of 4528 referred patients were identified, with a median age at referral of 3.0[IQR: 0.0-13.0] years. Of these, 1862 (41%) were female, 2000 (44%) were White Non-Hispanic, and 916 (20%) had a confirmed diagnosis of brain death at referral. OPO 1 accounted for 1523 (33%) referrals, and accidents were the leading cause of death (n = 1175, 26%). Next-of-kin were approached for organ donation in 1344 (30%) cases. After adjustment, when compared to White Non-Hispanic, next-of-kin for Hispanic (OR: 0.69;95% CI: 0.54-0.89, p = 0.005), Black (OR: 0.55;95% CI: 0.42-0.72, p < 0.001) and "Other"(OR: 0.64;95% CI: 0.43-0.96, p = 0.031) race patients were less likely to be approached. Among the approached next-of-kin, 819 (61%) consented to organ donation. Adjusted analyses demonstrated that, compared to White Non-Hispanic patients, next-of-kin for Hispanic (OR: 0.63;95% CI: 0.44-0.89; p = 0.010), Black (OR: 0.31;95% CI: 0.22-0.43, p < 0.001), and "Other"(OR: 0.37;95% CI: 0.20-0.66, p < 0.001) race patients were significantly less likely to consent.
Conclusions:
This study highlights the low approach rates for potential organ donors and the persistent racial disparities in the pediatric deceased organ donation process. Racial minority groups are less likely to be approached for donation and to provide consent compared to White individuals. These findings underscore the need for an equitable organ donation process to expand the pediatric donor pool.
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