RACE - A CRITICAL FACTOR IN ORGAN DONATION, PATIENT REFERRAL AND SELECTION, AND ORTHOTOPIC LIVER-TRANSPLANTATION

The influence of ethnic origin on organ donation and renal allograft s urvival after renal transplantation has been controversial. Several la rge studies have reported inferior renal allograft survival in black r ecipients, whereas others have reported equal survival, However, the i ssue of race as it relates to organ donation, patient referral, and pa tient selection in orthotopic liver transplantation has not been inves tigated. We retrospectively reviewed our results of organ donation, pa tient referral and selection, and orthotopic liver transplantation sin ce 1989, Because of a concerted educational effort by this organ procu rement organization, the percentage of black donors has increased from 6.1% in 1988 to 21.9% in 1996, Since the inception of the Liver Trans plant Program in 1989, 844 patients have been referred to our transpla nt center for organ transplant evaluation. Disproportionately fewer bl ack patients (119; 14.1%) were referred for liver transplantation than white patients (725; 85.9%) based on the prevalence of end-stage live r disease in these populations. The acceptance rate for listing for tr ansplantation was similar between the two groups. The percentage of pa tient referrals who actually underwent transplantation was similar acr oss racial lines (43% black v42% white patients). However, it appeared that black patients were referred for liver transplantation at a late r stage and were more critically ill at the time of referral. Neverthe less, the patient and graft survival were similar between black and wh ite patients. The 1- and 3-year survival rates in white recipients was 88% and 81%, respectively, versus 96% and 84% in black recipients, Wi thin this organ procurement organization, black donation has increased over the past 10 years. Unfortunately, there may be a selection bias at the level of referral for liver transplantation. However, once pati ents are referred to this center for liver transplantation, the rate o f transplantation and survival is similar between white and black pati ents. (C) 1998 by the American Association for the Study of Liver Dise ases.