Black Men May Be Less Likely to Receive Life-Saving Heart Transplants

Poor ethics in health care nothing new—and a new study out of Indiana University School of Medicine has shed light on racial and gender disparities with heart transplant recipients.

The study reviewed over 159,000 heart offers given to almost 15,000 candidates, and it found that women and white men were more likely to get offers over Black men. As far as those offers are concerned, oftentimes Black patients need to go through up to 16 hearts before finally matching with one.

Of the 15,000 candidates, 31 percent were Black, 69 percent were white, 74 percent were men, and 26 percent were women. As far as offers, Black candidates were less likely to accept their first offer. Khadijah Breathett, MD, MS, FACC, FAHA, FHFSA, associate professor of medicine at the IU School of Medicine and lead author of the study says “Black patients are less likely to be referred for a heart transplant, approved for transplant and receive a transplant after listing.”

Black patients also have a two to three times greater risk of developing heart failure than white patients, and they have an even greater risk of dying while waiting for a new heart. 

According to the Centers for Disease Control many factors contribute to Black people, especially men, having a greater risk of developing heart diseases that could lead to failure. Not only that, but they often develop heart disease at a younger age. Black men also have a 70% higher risk of heart failure compared to white men.

Lifestyle has a major impact, considering behaviors like smoking, having unhealthy diets, and having conditions like diabetes, obesity, high cholesterol, and hypertension contribute to one’s risk of developing heart disease and heart failure. Black men are more likely than white men have diabetes and/or hypertension, and they are also more likely to not have their levels under control.

Social determinants of health may also play a factor, as well, with access to healthy foods and quality-of-life impacting if and when someone may develop heart disease or any conditions that put that at risk.

Related: This Medical Device Could Worsen Heart Failure in Black Patients

How Black Americans are at risk for heart failure

Heart failure is also more concentrated in certain states with high rates of uninsured people, poverty, and crime rates. Mississippi, Oklahoma, Arkansas, South Carolina, Louisiana, and Alabama have higher rates of heart failure mortality compared to other states with healthier residents. 

Breathette points to structural racism and social determinants of health putting Black patients at risk for being diagnosed with life-threatening conditions, which can tie in with the role geography plays in SDOH. She says, “It is being increasingly recognized that structural racism contributes to biological changes such as increased inflammation and telomere shortening, which accelerates and increases severity of disease.”

A few reasons for the inequity in transplants, which were mentioned in the study, include team decision-making during selection, clinical factors, as well as implicit bias. According to Breathett, “We should provide centers with their data and incentivize them [to do] the right thing. Evidence-based bias training and anti-racism training are also important for centers to complete.”

Breathett puts onus on the computer algorithm that ranks and matches candidates and donors according to specific characteristics. That includes blood type, location, urgency, and severity of illness. From there, team members at a transplant center quickly review the information and decide whether to accept the organ donation.

Transplant inequities persist across various organs, and in 2021, Black patients received 22 percent of transplants. “I doubt it is intentional,” Breathett says, “But this study may demonstrate how bias leads to unfair decision-making that may mean life or death based upon race and gender.” 

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