ImportanceBarriers 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.ObjectiveTo 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.Design, Setting, and ParticipantsThis 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.ExposuresBlack or White race and gender (men, women) of a heart transplant candidate.Main Outcomes and MeasuresThe 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.ResultsAmong 159 177 heart offers with 13 760 donors, there were 14 890 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 (P < .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.Conclusions and RelevanceThe 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.

中文翻译：

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移植等待名单上患者的种族和性别对供体心脏接受程度的差异

重要性在上市之前必须克服心脏移植的障碍。目前还不清楚为什么黑人男性和女性在列入名单后接受心脏移植的可能性仍然低于白人男性和女性。目的评估心脏移植候选者（即移植等待名单上的患者）的种族或性别是否与概率相关设计、设置和参与者这项队列研究使用器官共享联合网络数据集来确定美国非西班牙裔黑人（以下简称“黑人”）和2018 年 10 月 18 日至 2023 年 3 月 31 日期间列入心脏移植名单的非西班牙裔白人（以下简称白人）成年人。暴露心脏移植候选者的黑人或白人种族和性别（男性、女性）。主要结果和措施主要结果是心脏报价被移植中心团队接受。使用离散事件时间分析、非参数（按种族和性别分层）和参数评估来评估录取的数量。使用根据候选者、捐赠者和要约级别变量进行调整的广义线性混合模型对每个要约接受的风险概率进行建模。结果在 13760 名捐赠者的 159177 份心脏要约中，有 14890 名候选人列出了心脏移植； 30.9% 为黑人，69.1% 为白人，73.6% 为男性，26.4% 为女性。白人女性接受录用的累积发生率最高，其次是黑人女性、白人男性和黑人男性（磷< .001）。从第一个录用通知到第 16 个录用通知，黑人候选人的接受几率低于白人候选人（比值比 [OR]，0.76；95% CI，0.69-0.84）。从第一次要约到第六次要约，女性的接受几率高于男性（OR，1.53；95% CI，1.39-1.68），而从第 10 次到第 31 个要约，女性的接受几率较低。结论和相关性心脏要约接受的累积发生率移植中心团队对黑人候选人的评分始终低于同性别白人候选人，而女性则高于男性。在调整候选人、捐赠者和录取水平变量后，这些差异仍然存在，这可能表明决策过程中存在种族和性别偏见。对现场决策的进一步调查可能会揭示公平接受捐赠心脏的策略。