12133 Background: Allogeneic stem cell transplant (alloSCT) is the only treatment associated with cure for high-risk myelodysplastic syndrome (MDS), but carries substantial risks. One routinely mentioned concern is donor source. While white patients have an 80% chance of finding an unrelated fully matched donor, Black patients have among the lowest chance at 30%. The aim of this secondary analysis, from a telemedicine study assessing how hematologists engage in shared decision making with patients considering alloSCT, is to analyze how hematologists navigate discussions about donor concerns related to the apparent race of the patient. Methods: This is a qualitative analysis of transcribed video-recorded virtual encounters. We recruited US hematologists who perform alloSCT and randomized them to meet with a patient actor of Black or white race. The hematologists conducted a new patient encounter with the actors who were trained to portray the same 67 year old man with newly diagnosed high-risk MDS referred for specialty consultation to discuss treatment options. The patient character had multiple healthy siblings and children. Results: Transcripts from a total of 33 hematologists were available at the time of analysis (61% male, 30% non-white, mean age 46 +/- 11 years). Hematologists spent varying amounts of time discussing the concept of transplant donation. While some used complex language to describe matching and HLA tissue markers, others used simplified terms of finding a donor with “an immune system that’s similar to your own,” to eradicate foreign MDS cells and avoid attack on healthy cells. The majority emphasized searching for a donor among siblings, given the highest likelihood of matching. Conversations with the white actor included reassurance of finding a fully matched donor, whether through family or the international registry. Hematologists frequently disclosed the highest chance of success for people of European ancestry. While hematologists mentioned the registry in conversations with the Black actor, they rarely disclosed the lower chance of finding a fully matched unrelated donor. Instead they reassured that with better technology haploidentical match could be an option through donation from their child, “with as favorable outcomes.” Some gave the Black actor an overestimation of finding a fully matched donor through the registry. Non-white hematologists more frequently acknowledged the concept of race in stem cell donation. Conclusions: Hematologists use multiple strategies to help patients understand the donor process. They reveal to white patients the high likelihood of finding a fully matched donor while appearing to avoid discussing the lower odds for a Black patient.