Anesthesiology August 2024, Vol. 141, A13–A15.
Differences in donor heart acceptance by race and gender of patients on the transplant waiting list. JAMA 2024; 331:1379–86. PMID: 38526480.
Approximately 40% of heart transplant recipients are from minoritized racial and ethnic groups, and approximately 25% of heart recipients are women. Black persons and women are less likely to be listed for heart transplantation. The matching process follows an algorithm, but decisions to accept offers are more nuanced and subjective. Black men and women are less likely than White men and women to receive a heart transplant after listing. Using the United Network for Organ Sharing, this cohort study identified organ acceptance with each offer for U.S. Black and non-Hispanic White adults listed for heart transplantation from October 18, 2018, to March 31, 2023. There were 14,890 candidates listed for heart transplantation; 30.9% Black, 69.1% White, 73.6% men, and 26.4% women for 159,177 offers from 13,760 donors. Offer acceptance was highest for White women followed by Black women, White men, and Black men (P < 0.001). Odds of acceptance were less for Blacks than for Whites for first offers (odds ratio, 0.76; 95% CI, 0.69 to 0.84) through the 16th offer. Odds of acceptance were higher for women than for men for first offers (odds ratio, 1.53; 95% CI, 1.39 to 1.68) through the sixth offer and were lower for offers 10 through 31.
Take home message: Transplant center teams consistently accepted heart offers at a lower rate for Black candidates than for White candidates of the same sex and at higher rates for women than for men.