According to data from the United Network for Organ Sharing (UNOS), some transplant teams showed patterns of denying donor hearts to certain patients when offers became available. The probability of a donor heart being accepted by these transplant centers was more likely for white women, followed by Black women, white men, then Black men, according to research.
Researchers found worse odds of acceptance for Black candidates than for white candidates for the first through sixth offer. Odds of acceptance were higher for women than for men for the first through sixth offer.
“While the registry data used in these analyses have been crucial for exposing disparities, it is time to fund more detailed analyses of these practices, including in-depth studies of social determinants of health and race-based differences in immune responses in the setting of organ transplantation,” said Paul Heidenreich, MD, MS, and two colleagues of Stanford University School of Medicine in California.
“What may be surprising to many is that most organ offers are refused by the transplant teams, and 44% of offered organs are never transplanted despite multiple offers,” Heidenreich noted. He said that 67% of refusals are attributed to poor-quality organs, the rest being judged a poor match for the patient or no longer suitable due to a change in the person’s clinical status.
Heidenreich’s full editorial about the racial disparity in heart failure and heart transplant care can be read here: Is Equity Being Traded for Access to Heart Transplant?
Gaming the System
UNOS and the Organ Procurement and Transplantation Network (OPTN) have acknowledged the shortcomings of the current six-tier allocation table, allowing some to game the system with overtreatment and exception requests. They are preparing to move the donor heart allocation to continuous distribution in which patients are scored mainly by medical urgency.
Regarding the abovementioned “gaming the system,” an article written in October 2022 about the heart transplant allocation system that was implemented in October 2018 states, in part:
The recent explosion in Status 2 transplant candidates with advanced heart failure would improbably suggest that “suddenly the entire country has sicker patients,” said Shelley Hall, MD, chief of transplant cardiology at Baylor Scott & White Health in Dallas and chair of the cardiac committee for UNOS.
Instead of patients actually becoming higher-acuity, the crowding of Status 2 is probably related to people getting devices — intra-aortic balloon pumps (IABPs), for example — to move nearer to the top of the transplant waitlist. “Are we putting balloon pumps in less ill patients? I’ll leave it there,” Hall said. Read the full text of this article here: UNOS to Revamp Heart Allocation Rules to Rein in Transplant Waitlist Tricks | MedPage Today
Upcoming Changes
The U.S. is in the process of restructuring the current donor heart allocation process, moving to the continuous distribution that is currently in use with other organs, most recently lungs.
This link explains the continuous distribution process:
Continuous distribution – OPTN (unos.org)
Delving deeper, this link digs into the granular details of what is being considered to adopt continuous allocation for heart transplant:
Continuous distribution – heart – OPTN (unos.org)
Many changes are upcoming in the world of organ transplants. The goal is to make organ allocation more equitable for all individuals, regardless of gender or ethnic background. Only time will tell if this goal will be successfully met.
Dawn Levitt, Author 