Donor hearts offered to female transplant candidates are more likely to be accepted than those offered to male candidates, according to new research published in JAMA.[1] The study’s authors also identified a similar disparity between Black and white patients, suggesting both gender and race continue to influence clinician decision-making more than care teams may realize.
“When a patient is listed for a heart transplant, the matching process for candidates and donors is fairly standardized,” wrote first author Khadijah Breathett, MD, MS, an associate professor of medicine with Indiana University School of Medicine, and colleagues. “A computer algorithm ranks and matches candidates and donors according to candidate characteristics and prespecified donor characteristics. Then, a transplant center is notified with an offer when the candidate is next in line with a matching donor. The designated team members at a transplant center must then review donor data and decide whether to accept the organ donation.”
Breathett et al. hoped to learn more about the decisions cardiothoracic surgeons and heart transplant cardiologists are making at those transplant centers. They explored data from the United Network for Organ Sharing (UNOS) on more than 159,000 heart offers made to more than 14,000 transplant candidates. Only white and Black adult candidates were included in this analysis. While 73.6% of transplant candidates were men, 26.4% were women. Meanwhile, 69.1% of candidates were white, and 30.9% were Black.
Overall, 11.4% of first offers were accepted by the patient’s care team. White women were the most likely to have a first offer accepted (17.5%), followed by Black women (14%), white men (10.3%) and Black men (7.9%). The median number of offers until one was finally accepted was five for white women, seven for Black women, nine for white men and 11 for Black men.
After making several adjustments to account for key variables, the researchers determined that a heart failure transplant request coming from a Black patient was 24% less likely to have a first offer accepted than a white candidate. In fact, this trend remained in place all the way until a 16th offer. On a similar note, female heart transplant candidates were 53% more likely to have a first offer accepted than a male candidate; this trend remained for the first six offers.
“The decisions to accept donor hearts were made by designated health care team members—generally a combination of cardiothoracic surgeons and/or heart transplant cardiologists—at each transplant center,” the authors wrote. “These disparities existed after adjusting for the pertinent donor-, patient-, and offer-level characteristics that may impact the decision to accept a donor heart. This finding suggests racial and gender bias as a potential contributor to the organ acceptance decision-making process.”
The group added that “unconscious bias and structural racism” are known to play a role in the way clinicians make day-to-day decisions and “it is possible” these factors are influencing the trends identified in this study.
“These issues could be generated from a false security that Black patients and/or men can wait longer for a better offer or from greater fear of a bad outcome with selecting an ‘imperfect’ donor for a particular race and/or gender,” they wrote.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.