Breathett Khadijah, Knapp Shannon M, Lewsey Sabra C, Mohammed Selma F, Mazimba Sula, Dunlay Shannon M, Hicks Albert, Ilonze Onyedika J, Morris Alanna A, Tedford Ryan J, Colvin Monica M, Daly Richard C
Krannert Cardiovascular Research Center, Division of Cardiovascular Medicine, Indiana University, Indianapolis.
Division of Cardiovascular Medicine, Johns Hopkins University, Baltimore, Maryland.
JAMA. 2024 Apr 23;331(16):1379-1386. doi: 10.1001/jama.2024.0065.
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.
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.
Black or White race and gender (men, women) of a heart transplant candidate.
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.
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.
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.
在列入名单之前必须克服心脏移植的障碍。目前尚不清楚为何黑人男性和女性在列入名单后接受心脏移植的可能性仍低于白人男性和女性。
评估心脏移植候选人（即移植等待名单上的患者）的种族或性别是否与移植中心团队每次提供供体心脏时接受的概率相关。
设计、设置和参与者：这项队列研究使用器官共享联合网络数据集，以确定2018年10月18日至2023年3月31日期间在美国列入心脏移植名单的非西班牙裔黑人（以下简称黑人）和非西班牙裔白人（以下简称白人）成年人每次提供器官时的接受情况。
心脏移植候选人的黑人或白人种族以及性别（男性、女性）。
主要结局是移植中心团队接受心脏供体。使用离散事件时间分析对接受供体的次数进行评估，采用非参数方法（按种族和性别分层）和参数方法。使用针对候选人、供体和供体提供层面变量进行调整的广义线性混合模型，对每次提供供体时接受的风险概率进行建模。
在13760名供体提供的159177次心脏供体中，有14890名候选人列入心脏移植名单；其中30.9%为黑人，69.1%为白人，73.6%为男性，26.4%为女性。移植中心团队接受供体的累积发生率最高的是白人女性，其次是黑人女性、白人男性和黑人男性（P < 0.001）。从第一次供体到第16次供体，黑人候选人接受供体的几率低于白人候选人（优势比[OR]，0.76；95%置信区间，0.69 - 0.84）。从第一次供体到第六次供体，女性接受供体的几率高于男性（OR，1.53；95%置信区间，1.39 - 1.68），而在第10次到第31次供体时则较低。
移植中心团队接受心脏供体的累积发生率，黑人候选人始终低于同性别白人候选人，女性高于男性。在对候选人、供体和供体提供层面变量进行调整后，这些差异仍然存在，这可能表明决策过程中存在种族和性别偏见。对机构层面决策的进一步调查可能会揭示公平接受供体心脏的策略。
