Racial and ethnic disparities on the heart transplant waiting list

Background: Racial disparities continue to affect countless individuals across the United States and is an ongoing issue in heart transplantation (HTx). Though inequities for post-transplant survival have been studied, there remains limited and conflicting data for waitlist outcomes. Our investigation aims to address this by analyzing mortality and transplantation outcomes on the heart transplant waiting list for various racial and ethnic groups. Methods: We analyzed adult patients listed for HTx between 1/2000-9/2023 using the UNOS database. Inclusion criteria included patients who identified as "White", "Black", "Hispanic", or "Asian". Patients with a prior HTx, those listed concurrently for heart-lung or lung transplants, and recipients who ultimately received a heterotopic HTx or multi-organ transplant, were excluded. Outcomes that were analyzed include waitlist mortality and odds of transplantation. Results: Over the course of the study period, the proportion of Black and Hispanic patients listed for HTx increased, while Asian groups remained stagnant and White individuals decreased. In the 21st century, we found that Black patients had increased mortality on the waitlist, however, this risk became negligible in the past decade. Odds of transplantation were significantly lower for Black and Hispanic patients, which persisted today even after implementation of the new allocation policy. Conclusion: Disparities continue to exist for minority groups, namely Black and Hispanic patients, in the listing process for a heart transplant. Outcomes for marginalized populations may be improved through continued training in bias awareness, increased diversity in the HTx evaluation team, and strengthened societal efforts to address social determinants of health.