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Racial Disparities in Donation After Circulatory Death Heart Transplant Listing Practices and Outcomes
Abstract   Peer reviewed

Racial Disparities in Donation After Circulatory Death Heart Transplant Listing Practices and Outcomes

P.D. Cho, J. White, H. Zappacosta, J. Song, S. McKay, A. Abramov, M. Husain, M. Daniel and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 28-28
Jul 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.067
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Abstract

Purpose: The donation after circulatory death (DCD) heart transplantation practice has expanded significantly in the United States (US), but whether all races receive equitable access remains unclear. We sought to assess racial differences in listing practices and outcomes in DCD heart transplantation. Methods: We included all adult isolated heart transplant candidates from 12/2019-6/2025 in the US. Differences in willingness to accept DCD hearts by race (White vs Black vs Hispanic) were assessed. The impact of DCD listing on waitlist mortality was assessed using multivariable competing risks regression. For DCD heart transplantation, post-transplant outcomes, including severe primary graft dysfunction (PGD) and 30 day mortality, were compared among the three racial groups. Kaplan-Meier and Cox regression analyses were conducted to evaluate 1-year survival following DCD transplantation. Results: A total of 20,451 heart transplant candidates were identified (White: 61.0%; Black: 27.1%, Hispanic: 11.9%). Black candidates were least likely to be listed for DCD heart transplantation (48.5% vs 42.6% vs 50.7%, p<0.001). After adjusting for covariates, Black race remained independently associated with lower odds for DCD listing (Table). For White and Black races, DCD listing was associated with reduced waitlist mortality. Post-transplant outcomes, including severe PGD and 30-day mortality, were similar among the three groups (p>0.05). One-year survival in DCD heart transplantation was similar among White, Black, and Hispanic race groups (88.5% vs 79.7% vs 81.6%, p=0.08). Furthermore, recipient race was not an independent predictor of 1-year survival post-transplant (p=0.22). Conclusion: Black race candidates are least likely to be listed for DCD heart transplantation despite reduced waitlist mortality and similar post-transplant outcomes. This disparity may represent a missed opportunity to further mitigate waitlist mortality and improve equity in access to heart transplantation.

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