Race, Gender, and Donor Heart Acceptance

Abstract

To the Editor Cardiac transplant is a lengthy process informed by social determinants of health and race-based differences. A recent study 1 revealed that Black candidates had lower cumulative incidence of heart offer acceptance by transplant center teams compared with White candidates, and offer acceptance was higher for women than for men. 1 The authors used the United Network for Organ Sharing datasets and included adults listed for heart transplant from 2018 to 2023. 1 This period included the COVID-19 pandemic, during which time transplant programs had resource challenges. 2 Moreover, many centers in the US reserved active status on the transplant waiting list only for patients with high waitlist mortality and illness severity during the COVID-19 pandemic. 3 A study of 22 997 patients reported that young Black recipients had a high risk of mortality in the first year after transplant, which may have been attributed to more severe illness and comorbidity prior to cardiac transplant. 4 Hence, we question how the COVID-19 pandemic influenced equitable heart transplant after listing.Furthermore, we would like to know why the authors of this study 1 did not consider geographical variation when explaining their findings. A study that used data from the United Network for Organ Sharing database reported that transplant centers with the most active waitlists had lower waitlist mortality. 5 Although this study assessed waitlist mortality and cardiac transplant outcomes, it highlighted the substantial differences in transplant performance among states across the US. We therefore are curious to know if some transplant team centers located in certain parts of the US had differential race and gender disparities in heart transplant allocation.