Differences in Donor Heart Acceptance by Race and Gender of Patients on the Transplant Waiting List.
JAMA
; 331(16): 1379-1386, 2024 04 23.
Article
en En
| MEDLINE
| ID: mdl-38526480
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, andParticipants:
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 andMeasures:
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 159â¯177 heart offers with 13â¯760 donors, there were 14â¯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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Negro o Afroamericano
/
Obtención de Tejidos y Órganos
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Trasplante de Corazón
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Población Blanca
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Disparidades en Atención de Salud
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Insuficiencia Cardíaca
Límite:
Adult
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Female
/
Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
JAMA
Año:
2024
Tipo del documento:
Article
Pais de publicación:
Estados Unidos