Comparative Analyses of Donor-Recipient Racial and Ethnic Disparities in Cardiothoracic Transplantation: A Study of the UNOS/OPTN Database

Abstract

<h3>Purpose</h3> Racial disparities are well-described in organ transplantation (Tx). However, previous analyses have not compared the demographics of the donor pool relative to the recipient pool. <h3>Methods</h3> The annual composition of donor organ pool, recipient waitlist pool, and Tx patient pool, were characterized with respect to racial/ethnic background using UNOS/OPTN STAR database for both heart (HTx) and lung (LTx) transplantation, 1989-2017. Annual recipient/donor "ratios" (RDR) were calculated for the waitlist and Tx list. Annual RDR was defined as the percentage (%) of a racial/ethnic group present within either the waitlist or Tx list for a given year, divided by that year's % of corresponding racial/ethnic group. An RDR >1.0 indicates relative overrepresentation, whereas RDR <1.0 indicates relative underrepresentation. <h3>Results</h3> For HTx, whites accounted for a majority of recipients as well as donors for the entire study period. [RDR, relatively constant, ∼1.0]. Blacks accounted for a steadily increasing % of recipients and to a lesser extent donors, over time [RDR, increased over time, ∼1.0-1.4]. Hispanics accounted for a modest increase in % of recipients and to a greater extent donors, over time [RDR, relatively constant, <0.8]. For LTx, whites accounted for a majority of recipients as well as donors for the entire study period [RDR, consistently >1.0, ranging ∼1.1-1.4]. Blacks accounted for a modest increase in % of recipients and to a greater extent donors, over time [RDR, relatively constant, consistently <0.6]. Hispanics accounted for a modest increase in % of recipients and to greater extent donors, over time [RDR, relatively constant, consistently <0.7]. <h3>Conclusion</h3> Relative to the representation within the donor population, Hispanic patients comprise a much lower than expected % of HTx recipients. Both Blacks and Hispanics are substantially underrepresented with respect to receiving LTx. These disparities may have an impact on organ allocation policies.