Rédaction Africa Links 24 with Deborah Balthazar
Published on 2024-03-25 15:00:35
Heart transplantation is often the best treatment for patients experiencing end-stage heart failure. The process involves getting on a waiting list and awaiting offers for a suitable donor heart. Recent research published in the Journal of the American Medical Association has highlighted disparities in the acceptance rates of donor heart offers based on gender and race. While both white and Black women have higher acceptance rates for offered hearts, Black men face longer wait times due to repeated rejections by transplant centers.
The study, led by Khadijah Breathett, revealed that the number of matched offers until acceptance was lower for women, especially white women, but higher for Black men. This disparity in acceptance rates raised concerns of bias influencing decision-making within transplant teams. Breathett, an advanced heart failure transplant cardiologist, suggested that biases and stereotypes may play a role in the discrepancies observed.
The process of matching patients with donor hearts is standardized, involving a computer algorithm to rank and match candidates based on various criteria. However, the ultimate decision to accept or reject a donor heart offer is subjective and influenced by factors such as the patient’s condition and the transplant team’s judgment. Michelle Kittleson, an advanced heart failure transplant cardiologist, emphasized the importance of reflecting on and improving program operations to address disparities in heart transplant access.
Changes in heart transplant allocation policies in 2018 prioritized the sickest patients, resulting in increased transplants and reduced wait times. Despite these improvements, disparities persist, with Black patients and women still less likely to receive heart transplants compared to white patients and men. The study’s analysis of UNOS data from 2018 to 2023 revealed lower acceptance rates for Black candidates compared to white candidates, even after adjusting for various factors.
Experts like Jaimin Trivedi highlighted the impact of implanted medical devices on priority levels, potentially affecting the number of donor heart offers received. The study also raised concerns about the allocation of hearts based on income disparities in accessing advanced medical devices like ECMO. More investigation is needed to address decision-making processes contributing to these disparities.
Moving forward, Breathett urged transplant centers to collect and analyze data on donor acceptance based on race, ethnicity, and gender to identify and mitigate patterns of bias. It is essential to approach these disparities with an open mind and implement changes to promote equity in the heart transplant process. As research continues to uncover potential sources of bias and disparity, efforts to address and rectify these issues are crucial for ensuring fair access to life-saving heart transplants.
