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Racial bias may impact U.S.A. heart transplant decisions

Donor hearts are less likely to be accepted by transplant centers for Black patients than for white patients, leaving Black patients waiting longer for the life-saving procedure, according to analysis of U.S.A. data on the procedures between 2018 and 2023.

Heart transplant candidates are paired with donor hearts by a computer algorithm that ranks and matches candidates and donors according to factors such as blood type, severity of illness, and location. When a patient is matched with a donor, the transplant team decides whether to accept or decline the heart for that patient.

That final determination incorporates many factors, including the condition of the donor heart, diseases the donor had, the cause of death, the size of the patient compared to the size of the donor, and how much time the heart will spend in storage.

“It is hard work to make sure that the decision is the right one,” study leader Dr. Khadijah Breathett of Indiana University School of Medicine said in a statement. “You do not want to accept a donation that will not be beneficial for the patient.”

The researchers looked only at offers of hearts that eventually got transplanted. But after taking individual patient and donor risk factors into account, they found many more hearts were offered before one was accepted for Black patients compared with white counterparts. Offers to men were also declined more often than women.

Researchers analyzed data on 14,890 patients listed for heart transplants between 2018 and 2023. About one-third were non-Hispanic Black; two-thirds were non-Hispanic white. Roughly 26% were women.

Overall, 11.4% of initial heart offers were accepted. For white women, 17.5% of first offers were accepted versus 14% for Black women, 10.3% for white men, and 7.9% for Black men, researchers reported on Monday in JAMA.

The median number of offers until doctors accepted a heart for a patient awaiting a transplant was five for white women, seven for Black women, nine for white men, and 11 for Black men.

“This study may demonstrate how bias leads to unfair decision-making that may mean life or death based upon race and gender,” Breathett said.

An editorial published with the study notes that while the data may reflect an unconscious bias against Black patients and male patients by transplant teams, it’s also possible the groups are different in ways that were not measured and might justify declining the organ.

Additionally, a new heart allocation system that prioritizes patients receiving intensive, high-cost treatments may be having unintended consequences for equity, the editorial suggests.