{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:55:23Z","timestamp":1793228123953,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,4,23]]},"abstract":"<jats:sec id=\"ab-joi240001-1\"><jats:title>Importance<\/jats:title><jats:p>Barriers to heart transplant must be overcome prior to listing. It is unclear why Black men and women remain less likely to receive a heart transplant after listing than White men and women.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240001-2\"><jats:title>Objective<\/jats:title><jats:p>To evaluate whether race or gender of a heart transplant candidate (ie, patient on the transplant waiting list) is associated with the probability of a donor heart being accepted by the transplant center team with each offer.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240001-3\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cohort study used the United Network for Organ Sharing datasets to identify organ acceptance with each offer for US non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) adults listed for heart transplant from October 18, 2018, through March 31, 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240001-4\"><jats:title>Exposures<\/jats:title><jats:p>Black or White race and gender (men, women) of a heart transplant candidate.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240001-5\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcome was heart offer acceptance by the transplant center team. The number of offers to acceptance was assessed using discrete time-to-event analyses, nonparametrically (stratified by race and gender) and parametrically. The hazard probability of offer acceptance for each offer was modeled using generalized linear mixed models adjusted for candidate-, donor-, and offer-level variables.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240001-6\"><jats:title>Results<\/jats:title><jats:p>Among 159\u202f177 heart offers with 13\u202f760 donors, there were 14\u202f890 candidates listed for heart transplant; 30.9% were Black, 69.1% were White, 73.6% were men, and 26.4% were women. The cumulative incidence of offer acceptance was highest for White women followed by Black women, White men, and Black men (<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Odds of acceptance were less for Black candidates than for White candidates for the first offer (odds ratio [OR], 0.76; 95% CI, 0.69-0.84) through the 16th offer. Odds of acceptance were higher for women than for men for the first offer (OR, 1.53; 95% CI, 1.39-1.68) through the sixth offer and were lower for the 10th through 31st offers.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240001-7\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The cumulative incidence of heart offer acceptance by a transplant center team was consistently lower for Black candidates than for White candidates of the same gender and higher for women than for men. These disparities persisted after adjusting for candidate-, donor-, and offer-level variables, possibly suggesting racial and gender bias in the decision-making process. Further investigation of site-level decision-making may reveal strategies for equitable donor heart acceptance.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2024.0065","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T15:02:05Z","timestamp":1711378925000},"page":"1379","source":"Crossref","is-referenced-by-count":45,"title":["Differences in Donor Heart Acceptance by Race and Gender of Patients on the Transplant Waiting List"],"prefix":"10.1001","volume":"331","author":[{"given":"Khadijah","family":"Breathett","sequence":"first","affiliation":[{"name":"Krannert Cardiovascular Research Center, Division of Cardiovascular Medicine, Indiana University, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon M.","family":"Knapp","sequence":"additional","affiliation":[{"name":"Krannert Cardiovascular Research Center, Division of Cardiovascular Medicine, Indiana University, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabra C.","family":"Lewsey","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selma F.","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Creighton University, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sula","family":"Mazimba","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Virginia, Charlottesville"},{"name":"AdventHealth, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon M.","family":"Dunlay","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Hicks","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Maryland, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onyedika J.","family":"Ilonze","sequence":"additional","affiliation":[{"name":"Krannert Cardiovascular Research Center, Division of Cardiovascular Medicine, Indiana University, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanna A.","family":"Morris","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"Tedford","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M.","family":"Colvin","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C.","family":"Daly","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"24","key":"joi240001r1","doi-asserted-by":"publisher","first-page":"2412","DOI":"10.1161\/CIRCULATIONAHA.120.052254","article-title":"Imbalance in heart transplant to heart failure mortality ratio among African American, Hispanic, and White patients.","volume":"143","author":"Breathett","year":"2021","journal-title":"Circulation"},{"issue":"17","key":"joi240001r2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.020146","article-title":"Imbalance in heart transplant to heart failure mortality ratio by 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