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. 2024 Apr 23;331(16):1379-1386.
doi: 10.1001/jama.2024.0065.

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

Khadijah Breathett  1 , Shannon M Knapp  1 , Sabra C Lewsey  2 , Selma F Mohammed  3 , Sula Mazimba  4   5 , Shannon M Dunlay  6 , Albert Hicks  7 , Onyedika J Ilonze  1 , Alanna A Morris  8 , Ryan J Tedford  9 , Monica M Colvin  10 , Richard C Daly  11
Affiliations

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

Khadijah Breathett et al. JAMA. .

Abstract

Importance: Barriers to heart transplant must be overcome prior to listing. It is unclear why Black men and women remain less likely to receive a heart transplant after listing than White men and women.

Objective: To evaluate whether race or gender of a heart transplant candidate (ie, patient on the transplant waiting list) is associated with the probability of a donor heart being accepted by the transplant center team with each offer.

Design, setting, and participants: This cohort study used the United Network for Organ Sharing datasets to identify organ acceptance with each offer for US non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) adults listed for heart transplant from October 18, 2018, through March 31, 2023.

Exposures: Black or White race and gender (men, women) of a heart transplant candidate.

Main outcomes and measures: The main outcome was heart offer acceptance by the transplant center team. The number of offers to acceptance was assessed using discrete time-to-event analyses, nonparametrically (stratified by race and gender) and parametrically. The hazard probability of offer acceptance for each offer was modeled using generalized linear mixed models adjusted for candidate-, donor-, and offer-level variables.

Results: Among 159 177 heart offers with 13 760 donors, there were 14 890 candidates listed for heart transplant; 30.9% were Black, 69.1% were White, 73.6% were men, and 26.4% were women. The cumulative incidence of offer acceptance was highest for White women followed by Black women, White men, and Black men (P < .001). Odds of acceptance were less for Black candidates than for White candidates for the first offer (odds ratio [OR], 0.76; 95% CI, 0.69-0.84) through the 16th offer. Odds of acceptance were higher for women than for men for the first offer (OR, 1.53; 95% CI, 1.39-1.68) through the sixth offer and were lower for the 10th through 31st offers.

Conclusions and relevance: The cumulative incidence of heart offer acceptance by a transplant center team was consistently lower for Black candidates than for White candidates of the same gender and higher for women than for men. 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Breathett reported receiving grants from the National Heart, Lung, and Blood Institute and the Indiana Clinical and Translational Sciences Institute outside the submitted work. Dr Mohammed reported receiving speaker fees from the National Association for Continuing Education, study funding from AstraZeneca and Medtronic outside the submitted work. Dr Tedford reported receiving personal fees from and serving on a steering committee and as a consultant for Abbott, Edwards, and Merck; receiving personal fees from and serving on an advisory committee for Medtronic; receiving personal fees from and being a consultant for Acorai, Alleviant, Cytokinetics, CareDx, Gradient, lexicon, and United Therapeutics; serving as a consultant for and having stock options in Aria CV; and receiving personal fees and travel reimbursement from and serving on the advisory committee for Abiomed outside the submitted work. Dr Daly reported being Chair of the Heart Transplantation Committee for the Organ Procurement & Transplantation Network. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cumulative Incidence Function of Accepting a Donor Organ With Each Offer Stratified by Candidate Race and Gender
The unadjusted cumulative incidence of offer acceptance is provided by candidate race and gender for each matching offer up to the 50th offer.
Figure 2.
Figure 2.. Adjusted Odds Ratio of Accepting a Donor Organ With Each Offer by Candidate Race and Gender
The adjusted odds ratios of offer acceptance are provided as the odds for Black candidates compared with the odds for White candidates and the odds for women compared with the odds for men for each matching offer up to the 50th offer, with 95% CIs per the model.
See this image and copyright information in PMC

Comment in

References

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