Black men may be less likely to receive a heart transplant than white men and women

Black patients who need a heart transplant may be less likely to receive one than white patients, according to a new study led by researchers at Indiana University School of Medicine.

the study, recently published in Japan Automobile Manufacturers Associationanalyzed for the first time data on organ acceptance for black and white patients on heart transplant waiting lists. The research team used information from the Organ Sharing Network on patients listed for heart transplants in the United States from October 2018 to March 2023. Of the 14,890 heart transplant candidates, approximately 31% were non-Hispanic black and 69% were non-Hispanic black.・Hispanic white, approximately 26% female.

Researchers found that white candidates were more likely to be accepted than black candidates. The odds were also higher for women than for men.

“Black patients are two to three times more likely to develop heart failure than white patients and have the highest risk of dying from heart failure compared to other races and ethnicities,” said Khadijah Brisette, MD, MSc, FACC. Ta. FAHA, FHFSA, associate professor at IU School of Medicine and lead author of this study. “However, Black patients are less likely to be referred for a heart transplant, to be approved for a transplant, and to receive a transplant after enrollment. The intersection of race and gender often exacerbates access for Black women.”

Dr. Brisette, a physician-scientist at IU School of Medicine’s Krannert Cardiovascular Research Center and a cardiologist at Indiana University Health, explains that when a patient is registered as a candidate for a heart transplant, computer algorithms select candidates based on certain characteristics. The company said it would rank and match donors with donors. , blood type, severity of disease, urgency of transplant, location, etc. A designated team member at the transplant center will review the data and decide whether to accept the organ donation.

“As the algorithms for matching patients and donors are changing across all organs, there is a great opportunity for transplant teams to better understand whether the decision to accept a donated organ differs by patient race or gender. “It became,” she said. “We want to understand how the process of getting a transplant after being listed varies by race and gender, and a combination of the two, and take steps to make that process more fair.” That’s what I thought.”

Brisette said that after the algorithm, clinicians must quickly make a final decision on whether the donated heart is good enough for the patient. They consider things like the physiology of the heart, the various diseases the donor had, the cause of death, the size of the patient compared to the size of the donor, and the distance between hospitals.

“It’s a lot of work to make sure the decision is the right one,” Brissett said. “We don’t want to accept donations that don’t benefit the patient. In our study, we took the step of only targeting ‘good hearts,’ that is, hearts that were ultimately largely accepted by some team.” . Our findings are alarming. Overall, we found that the decision to accept ‘good intentions’ required more matching before acceptance for black patients than for white patients and for men than for women. ”

Brisette is also leading a national randomized cluster trial and implementation science study that has the potential to make the approval process more fair. She hopes the results of both studies will help address structural racism in healthcare.

“Structural racism contributes to increasing social determinants of health and decreasing access to quality and timely care,” Brisette said. “We are increasingly recognizing that structural racism contributes to biological changes such as increased inflammation and shortened telomeres, which accelerate disease severity.”

In the future, Brisette said she would like to see hospitals and organ transplant centers consider their own data on transplants and patients’ race and gender and provide incentives to make changes that lead to more equitable care. .

“While we do not believe it was intentional, this study may show how bias can lead to unfair life-or-death decisions based on race or gender,” Brisette said. Ta. “We should provide data to centers and encourage them to do the right thing. It is also important that centers complete evidence-based bias training and anti-racism training.”

Other study authors from IU include Shannon Knapp, Ph.D., and Onyedika Ilonzeh, MD.