Not By Choice: Black Patients With Advanced Heart Failure Are Less Likely To Receive A Vad Or Transplant Despite Their Preferences For Care

Differences in Donor Heart Acceptance by Race and Gender of Patients on the Transplant Waiting List

“…Last, unconscious bias and structural racism are known contributors in clinical decision-making 30,31 and have been shown to influence heart transplant allocation processes. 9,10,14 It is possible that bias and structural racism may also influence the decision to accept an organ. 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.…”

“…Multiple studies have identified significant contributors to inequitable allocation, such as variable referral patterns, inequitable transplant team decisionmaking during selection for listing (subjectivity in the assessment of social support systems and adherence, variability in the weight of social determinants of health, and poor group dynamics), and clinical factors. 1,2,[9][10][11][12][13][14][15] Bias against minoritized groups has also contributed to the inequitable allocation processes. 9,10,14 It is unclear why minoritized racial and ethnic groups and women are less likely to receive a transplant after these barriers have been addressed to the point that the patient is deemed appropriate to be listed for heart transplant.…”

“…1,2,[9][10][11][12][13][14][15] Bias against minoritized groups has also contributed to the inequitable allocation processes. 9,10,14 It is unclear why minoritized racial and ethnic groups and women are less likely to receive a transplant after these barriers have been addressed to the point that the patient is deemed appropriate to be listed for heart transplant.…”