The odds in the United States that a well-functioning donor heart will go to a Black man are lower than for white transplant candidates of either gender, new research shows.

The news is troubling, since “Black patients have a two to three times greater risk of developing heart failure than white patients, and they have the highest risk of dying from heart failure compared with all other racial and ethnic groups,” said study author Dr. Khadijah Breathett. She is an associate professor of medicine at the Indiana University School of Medicine in Indianapolis.

The new study, published March 25 in the Journal of the American Medical Association, tracked what is known as the “acceptance” of donor hearts by health care teams who care for candidate recipients for transplant.

Breathett’s team looked at data from United Network for Organ Sharing (UNOS) from late 2018 to March of 2023.

Of the nearly 15,000 Americans waiting on a list for a donor heart, 69% were white and 31% were Black. About 74% were men.

Black candidates (of either gender) for heart transplant were 24% less likely to be accepted for a healthy donor heart compared to white candidates of ether gender, the study found. That was true for multiple “offers” of a donor heart.

Women tended to be more readily accepted for donor hearts than men, the study found.

Ranked by likelihood of receiving a healthy donor heart, white women ranked highest, followed by Black women, then white men and finally Black men, the research showed.

“Black patients are less likely to be referred for a heart transplant, approved for transplant and receive a transplant after listing,” Breathett said in a university news release. “The intersection of race and gender often worsens access for Black women.”

Breathett is also a cardiologist at Indiana University Health. She explained that organ transplants currently rely on a computer algorithm that matches candidates and donors based on various factors, such as blood type, severity of illness, urgency for transplant and location.

Next, members of the transplant team review the data and make a decision as to whether to accept the heart for a particular patient in need.

 “We wanted to understand how the process of receiving a transplant after listing varied by race and gender, and the combination of the two, so that steps can be taken to make that process more equitable,” Breathett explained.

She stressed that decisions as to who gets a donor heart aren’t easy.

Transplant teams need to look at whether the heart suits the patient in terms of body size, the health of the donor, how the donor died and the travel distance between the donor’s hospital and that of the prospective recipient.

“It is hard work to make sure that the decision is the right one,” Breathett said. “You do not want to accept a donation that will not be beneficial for the patient. Our study took the step of only including ‘good hearts,’ or hearts that were for the most part eventually accepted by some team. Our discovery is concerning. Overall, we found that the decision to accept a ‘good heart’ requires many more matches prior to acceptance for Black patients than for white patients and for men than for women.”

So why are Black men who need a new heart often the last to receive one?

“I doubt it is intentional, but this study may demonstrate how bias leads to unfair decision-making that may mean life or death based upon race and gender,” Breathett said.

She theorized that structural racism in society as a whole could play a role.

“Structural racism contributes to increased social determinants of health and less access to quality and timely care,” Breathett explained. She said there’s more and more data showing that “structural racism contributes to biological changes” that can hasten and worsen illness among Black Americans.

All of this can be addressed by transplant centers that are aware of inequities in who gets donor organs.

“We should provide centers with their data and incentivize them for doing the right thing,” Breathett said. “Evidence-based bias training and anti-racism training are also important for centers to complete.”

More information

Find out more about how organ transplants work at UNOS.

SOURCE: Indiana University, news release, March 25, 2024

Source: HealthDay

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