PDF(Pubmed)
Abstract：
Barriers to heart transplant must be overcome prior to listing. It is unclear why Black men and women remain less likely to receive a heart transplant after listing than White men and women.
To evaluate whether race or gender of a heart transplant candidate (ie, patient on the transplant waiting list) is associated with the probability of a donor heart being accepted by the transplant center team with each offer.
This cohort study used the United Network for Organ Sharing datasets to identify organ acceptance with each offer for US non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) adults listed for heart transplant from October 18, 2018, through March 31, 2023.
Black or White race and gender (men, women) of a heart transplant candidate.
The main outcome was heart offer acceptance by the transplant center team. The number of offers to acceptance was assessed using discrete time-to-event analyses, nonparametrically (stratified by race and gender) and parametrically. The hazard probability of offer acceptance for each offer was modeled using generalized linear mixed models adjusted for candidate-, donor-, and offer-level variables.
Among 159 177 heart offers with 13 760 donors, there were 14 890 candidates listed for heart transplant; 30.9% were Black, 69.1% were White, 73.6% were men, and 26.4% were women. The cumulative incidence of offer acceptance was highest for White women followed by Black women, White men, and Black men (P < .001). Odds of acceptance were less for Black candidates than for White candidates for the first offer (odds ratio [OR], 0.76; 95% CI, 0.69-0.84) through the 16th offer. Odds of acceptance were higher for women than for men for the first offer (OR, 1.53; 95% CI, 1.39-1.68) through the sixth offer and were lower for the 10th through 31st offers.
The cumulative incidence of heart offer acceptance by a transplant center team was consistently lower for Black candidates than for White candidates of the same gender and higher for women than for men. These disparities persisted after adjusting for candidate-, donor-, and offer-level variables, possibly suggesting racial and gender bias in the decision-making process. Further investigation of site-level decision-making may reveal strategies for equitable donor heart acceptance.
To evaluate whether race or gender of a heart transplant candidate (ie, patient on the transplant waiting list) is associated with the probability of a donor heart being accepted by the transplant center team with each offer.
This cohort study used the United Network for Organ Sharing datasets to identify organ acceptance with each offer for US non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) adults listed for heart transplant from October 18, 2018, through March 31, 2023.
Black or White race and gender (men, women) of a heart transplant candidate.
The main outcome was heart offer acceptance by the transplant center team. The number of offers to acceptance was assessed using discrete time-to-event analyses, nonparametrically (stratified by race and gender) and parametrically. The hazard probability of offer acceptance for each offer was modeled using generalized linear mixed models adjusted for candidate-, donor-, and offer-level variables.
Among 159 177 heart offers with 13 760 donors, there were 14 890 candidates listed for heart transplant; 30.9% were Black, 69.1% were White, 73.6% were men, and 26.4% were women. The cumulative incidence of offer acceptance was highest for White women followed by Black women, White men, and Black men (P < .001). Odds of acceptance were less for Black candidates than for White candidates for the first offer (odds ratio [OR], 0.76; 95% CI, 0.69-0.84) through the 16th offer. Odds of acceptance were higher for women than for men for the first offer (OR, 1.53; 95% CI, 1.39-1.68) through the sixth offer and were lower for the 10th through 31st offers.
The cumulative incidence of heart offer acceptance by a transplant center team was consistently lower for Black candidates than for White candidates of the same gender and higher for women than for men. These disparities persisted after adjusting for candidate-, donor-, and offer-level variables, possibly suggesting racial and gender bias in the decision-making process. Further investigation of site-level decision-making may reveal strategies for equitable donor heart acceptance.
摘要：
■在上市之前必须克服心脏移植的障碍。目前还不清楚为什么黑人男性和女性在上市后接受心脏移植的可能性比白人男性和女性低。
■评估心脏移植候选人的种族或性别（即，移植等待名单上的患者）与移植中心团队接受供体心脏的可能性相关。
■这项队列研究使用了联合器官共享网络数据集，以确定每个美国非西班牙裔黑人的器官接受度（以下简称，黑人)和非西班牙裔白人(以下，白色）成年人将于2018年10月18日至2023年3月31日进行心脏移植。
■黑人或白人种族和性别（男性，女性）的心脏移植候选人。
■主要结果是移植中心团队接受心脏提供。使用离散的事件时间分析评估了接受要约的数量，非参数化(按种族和性别分层)和参数化。使用针对候选人调整的广义线性混合模型对每个要约的要约接受的风险概率进行建模-donor-,和报价级别的变量。
■在159177个心脏项目中，有13760个捐献者，有14890名候选人被列入心脏移植名单；30.9%是黑人，69.1%是白人，73.6%是男性,妇女占26.4%。白人女性接受要约的累积发生率最高，其次是黑人女性，白人,和黑人（P<0.001）。黑人候选人的接受几率低于白人候选人的第一次报价(赔率比[OR]，0.76；95%CI，0.69-0.84）至第16次报价。女性接受第一次报价的可能性高于男性(或，1.53；95%CI，1.39-1.68）到第六次报价，而在第10到31次报价中更低。
■移植中心团队接受心脏提供的累积发生率对于黑人候选人始终低于相同性别的白人候选人，而女性则高于男性。这些差距在调整候选人后仍然存在-，donor-,和报价级别的变量，可能暗示在决策过程中存在种族和性别偏见。对站点级别决策的进一步调查可能会揭示公平接受供体心脏的策略。
■评估心脏移植候选人的种族或性别（即，移植等待名单上的患者）与移植中心团队接受供体心脏的可能性相关。
■这项队列研究使用了联合器官共享网络数据集，以确定每个美国非西班牙裔黑人的器官接受度（以下简称，黑人)和非西班牙裔白人(以下，白色）成年人将于2018年10月18日至2023年3月31日进行心脏移植。
■黑人或白人种族和性别（男性，女性）的心脏移植候选人。
■主要结果是移植中心团队接受心脏提供。使用离散的事件时间分析评估了接受要约的数量，非参数化(按种族和性别分层)和参数化。使用针对候选人调整的广义线性混合模型对每个要约的要约接受的风险概率进行建模-donor-,和报价级别的变量。
■在159177个心脏项目中，有13760个捐献者，有14890名候选人被列入心脏移植名单；30.9%是黑人，69.1%是白人，73.6%是男性,妇女占26.4%。白人女性接受要约的累积发生率最高，其次是黑人女性，白人,和黑人（P<0.001）。黑人候选人的接受几率低于白人候选人的第一次报价(赔率比[OR]，0.76；95%CI，0.69-0.84）至第16次报价。女性接受第一次报价的可能性高于男性(或，1.53；95%CI，1.39-1.68）到第六次报价，而在第10到31次报价中更低。
■移植中心团队接受心脏提供的累积发生率对于黑人候选人始终低于相同性别的白人候选人，而女性则高于男性。这些差距在调整候选人后仍然存在-，donor-,和报价级别的变量，可能暗示在决策过程中存在种族和性别偏见。对站点级别决策的进一步调查可能会揭示公平接受供体心脏的策略。
