Transplant teams are less likely to accept donor hearts for Black men

A study published in JAMA on March 25, 2024, found racial and gender disparities in donor heart acceptances by transplant center teams, noting that Black men on the wait list were the least likely to have a heart accepted while White women had the highest acceptance rates.

The racial disparities in the organ transplant system are not a new discovery. Many barriers, including social factors like racism and financial factors, inhibit access to transplants and organs for patients in minorities and marginalized communities.

This JAMA study wanted to quantify and assess whether the race or gender of a heart transplant candidate or potential recipient correlated with varying probabilities of donor heart acceptance by the transplant center team.

Using data from the United Network for Organ Sharing (UNOS) datasets, researchers evaluated individuals on the heart transplant list from October 18, 208, to March 31, 2023. They focused on and compared genders, male and female, and race, as well as non-Hispanic Black and non-Hispanic White.

The researchers assessed the outcome in two ways. First, they determined whether the transplant team accepted a heart offer. Additionally, they conducted a discrete time-to-event analysis to understand the number of offers to acceptance.

The analysis revealed that the acceptance incidence was highest for White women and lowest for Black men, with Black women and White men falling consecutively in between.

According to the data, the transplant center teams accepted 11.4% of all first-time offers. However, after stratifying the patient population, the researchers noted that first-time acceptances were highest for White women at 17.5%. Comparatively, first-time acceptances for Black women, White men, and Black men were 14.0%, 10.3%, and 7.9%, respectively.

The investigators noted that up until offer 50, the order of acceptance rates remained the same. White women continued to have the highest acceptances, while Black men had the lowest. For example, by offer 10, 68.4% of white women had an accepted offer, while only 48.0% of Black men did.

“These disparities persisted after adjusting for candidate-, donor-, and offer-level variables, possibly suggesting racial and gender bias in the decision-making process. Further investigation of site-level decision-making may reveal strategies for equitable donor heart acceptance,” concluded the researchers.