Effect of Recipient Race on Quality of Donors Allocated to Heart Transplant Recipients

Abstract

Purpose Black heart transplant (HT) recipients have worse overall survival than other ethnic groups. It is unknown if subconscious racial bias affects the quality of donors that are allocated to black HT recipients. This study aims to investigate if the quality of donors allocated to HT recipients differs based on the race of the recipient. Methods We queried the Scientific Registry of Transplant Recipients (SRTR) dataset from 2006-2015. Patients were stratified into groups by race: black, white, Hispanic and other. Baseline characteristics of recipients were recorded in addition to independent donor variables including: donor age, ischemic time, creatinine, and size mismatch of greater than 20% difference in height or weight. Race-mismatch was not used as a variable due to disproportionate distribution of donor race in the population studied. We then compared these continuous variables across different racial groups. Results A total of 19171 HT recipients were included in the analysis: 3811 black, 13059 white, 1487 Hispanic, and 814 other. Black patients received donors with a significantly lower ischemic time (min) compared to white patients (188.9 ± 1.9 vs. 194.8 ± 1.1, p<0.001), and a significantly higher creatinine (mg/dL) than white patients (1.41 ± 0.09 vs 1.35 ± 0.04, p<0.001). In addition, white patients received donors of significantly older age (yr) than black and Hispanic patients (31.95 ± 0.4 vs 31.56 ± 0.7; 30.6 ± 1.1, respectively, p< 0.001) and "other" race was a significant risk for size mismatch compared to blacks, whites and Hispanics (39 ± 6.7% vs 35 ± 3%; 33 ± 1.6%; 31 ± 4.7% respectively, p<0.001). However, no other significant trends were noted. Conclusion Though there were some statistically significant results, most notably, our study did not find any meaningful clinically significant differences in the quality of donors allocated to HT recipients based on race. Though black HT recipients have worse outcomes than other ethnic groups, this effect may not be related to racial bias in organ allocation. Black heart transplant (HT) recipients have worse overall survival than other ethnic groups. It is unknown if subconscious racial bias affects the quality of donors that are allocated to black HT recipients. This study aims to investigate if the quality of donors allocated to HT recipients differs based on the race of the recipient. We queried the Scientific Registry of Transplant Recipients (SRTR) dataset from 2006-2015. Patients were stratified into groups by race: black, white, Hispanic and other. Baseline characteristics of recipients were recorded in addition to independent donor variables including: donor age, ischemic time, creatinine, and size mismatch of greater than 20% difference in height or weight. Race-mismatch was not used as a variable due to disproportionate distribution of donor race in the population studied. We then compared these continuous variables across different racial groups. A total of 19171 HT recipients were included in the analysis: 3811 black, 13059 white, 1487 Hispanic, and 814 other. Black patients received donors with a significantly lower ischemic time (min) compared to white patients (188.9 ± 1.9 vs. 194.8 ± 1.1, p<0.001), and a significantly higher creatinine (mg/dL) than white patients (1.41 ± 0.09 vs 1.35 ± 0.04, p<0.001). In addition, white patients received donors of significantly older age (yr) than black and Hispanic patients (31.95 ± 0.4 vs 31.56 ± 0.7; 30.6 ± 1.1, respectively, p< 0.001) and "other" race was a significant risk for size mismatch compared to blacks, whites and Hispanics (39 ± 6.7% vs 35 ± 3%; 33 ± 1.6%; 31 ± 4.7% respectively, p<0.001). However, no other significant trends were noted. Though there were some statistically significant results, most notably, our study did not find any meaningful clinically significant differences in the quality of donors allocated to HT recipients based on race. Though black HT recipients have worse outcomes than other ethnic groups, this effect may not be related to racial bias in organ allocation.