In Reply.
Ms. Majeed and colleagues pose important questions regarding our study.1 First, the COVID-19 pandemic has several possible implications for transplant care. To explore these implications, we reexamined the number of donor heart offers until acceptance as in the original article,1 but censored observations after February 29, 2020, to exclude the COVID-19 period. For both analyses, we maintained the start date of October 18, 2018, because the United Network for Organ Sharing changed heart transplant listing criteria on this date. The pattern was consistent with our original findings1 with the median number of offers until acceptance lowest for White women (5; 95% CI, 4-5), followed by Black women (6; 95% CI, 5-7), White men (8; 95% CI, 7-8), and Black men (9; 95% CI, 8-10; log-rank test p-value <0.001) (Figure). This suggests that these racial and gender disparities in acceptance of heart donors by transplant centers predated the COVID-19 pandemic and persisted during COVID-19.
Figure.
Pre-COVID-19 Cumulative Incidence Function Of Accepting A Donor Heart With Each Offer From October 18, 2018 To February 29, 2020
Second, it is important to note that in our initial study and in this analysis, we included only donors who were ultimately accepted, representing “good hearts.” As programs reevaluate their donor acceptance patterns, we recommend focusing on the donor matches that were ultimately accepted by another transplant program and considering whether patient race and gender were associated with donor acceptance at the program level. We are investigating geographical and center-level characteristics that may be associated with the decision to accept a matched donor heart according to patient race and gender. These findings will be published separately upon completion.
Multiple decisions must be aligned for patients to receive a timely heart transplant and have optimal survival. Often patient characteristics such as race, ethnicity, and gender unjustly contribute to the healthcare professional decision matrix, particularly for Black patients.2,3 Implementation science strategies should be prioritized to achieve equity in identification and delivery of appropriate care in heart transplant.4
References
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