Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Surg. 2021 Apr 1;156(4):e207083. doi: 10.1001/jamasurg.2020.7083. Epub 2021 Apr 14.
Historically, deceased organ donation was lower among Black compared with White populations, motivating efforts to reduce racial disparities. The overarching effect of these efforts in Black and other racial/ethnic groups remains unclear.
To examine changes in deceased organ donation over time.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from January 1, 1999, through December 31, 2017, from the Scientific Registry of Transplant Recipients to quantify the number of actual deceased organ donors, and from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Detailed Mortality File to quantify the number of potential donors (individuals who died under conditions consistent with organ donation). Data were analyzed from December 2, 2019, to May 14, 2020.
Race and ethnicity of deceased and potential donors.
For each racial/ethnic group and year, a donation ratio was calculated as the number of actual deceased donors divided by the number of potential donors. Direct age and sex standardization was used to allow for group comparisons, and Poisson regression was used to quantify changes in donation ratio over time.
A total of 141 534 deceased donors and 5 268 200 potential donors were included in the analysis. Among Black individuals, the donation ratio increased 2.58-fold from 1999 to 2017 (yearly change in adjusted incidence rate ratio [aIRR], 1.05; 95% CI, 1.05-1.05; P < .001). This increase was significantly greater than the 1.60-fold increase seen in White individuals. Nevertheless, substantial racial differences remained, with Black individuals still donating at only 69% the rate of White individuals in 2017 (P < .001). Among other racial minority populations, changes were less drastic. Deceased organ donation increased 1.80-fold among American Indian/Alaska Native and 1.40-fold among Asian or Pacific Islander populations, with substantial racial differences remaining in 2017 (American Indian/Alaska Native population donation at 28% and Asian/Pacific Islander population donation at 85% the rate of the White population). Deceased organ donation differences between Hispanic/Latino and non-Hispanic/Latino populations increased over time (4% lower in 2017).
The findings of this cohort study suggest that differences in deceased organ donation between White and some racial minority populations have attenuated over time. The greatest gains were observed among Black individuals, who have been the primary targets of study and intervention. Despite improvements, substantial differences remain, suggesting that novel approaches are needed to understand and address relatively lower rates of deceased organ donation among all racial minorities.
历史上，与白人相比，黑人的已故器官捐献率较低，这促使人们努力减少种族差异。这些努力在黑人和其他种族/族裔群体中的总体效果仍不清楚。
研究随时间推移已故器官捐献的变化。
设计、地点和参与者：这项基于人群的队列研究使用了 1999 年 1 月 1 日至 2017 年 12 月 31 日来自科学器官移植受者登记处的数据来量化实际已故器官捐献者的数量，并使用疾病控制和预防中心的广泛在线数据进行了研究详细的死亡率文件来量化潜在供体的数量（在符合器官捐献条件下死亡的个人）。数据分析于 2019 年 12 月 2 日至 2020 年 5 月 14 日进行。
已故和潜在供体的种族和民族。
对于每个种族/族裔群体和年份，计算捐献率作为实际已故捐献者的数量除以潜在捐献者的数量。直接年龄和性别标准化用于允许组间比较，并使用泊松回归来量化随时间推移的捐献率变化。
共纳入 141534 名已故捐献者和 5268200 名潜在捐献者进行分析。在黑人中，从 1999 年到 2017 年，捐献率增加了 2.58 倍（调整后发病率比的年变化率，1.05；95%CI，1.05-1.05；P<0.001）。这一增长明显大于白人的 1.60 倍。尽管如此，仍然存在显著的种族差异，黑人在 2017 年仅捐献了白人的 69%（P<0.001）。在其他少数族裔人群中，变化不那么剧烈。美国印第安人/阿拉斯加原住民的已故器官捐献增加了 1.80 倍，亚洲或太平洋岛民的捐献增加了 1.40 倍，2017 年仍存在显著的种族差异（美国印第安人/阿拉斯加原住民的捐献率为白人的 28%，亚洲/太平洋岛民的捐献率为白人的 85%）。西班牙裔/拉丁裔和非西班牙裔/拉丁裔人群之间的器官捐献差异随着时间的推移而增加（2017 年下降 4%）。
这项队列研究的结果表明，白人和一些少数族裔人群之间已故器官捐献的差异随时间的推移而减弱。黑人的获益最大，他们一直是研究和干预的主要目标。尽管有所改善，但仍存在显著差异，这表明需要新的方法来理解和解决所有少数族裔人群中相对较低的已故器官捐献率。
