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Original Investigation
February 10, 2021

Examination of Racial and Ethnic Differences in Deceased Organ Donation Ratio Over Time in the US

Author Affiliations
  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
  • 4Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
JAMA Surg. Published online February 10, 2021. doi:10.1001/jamasurg.2020.7083
Key Points

Question  How has deceased organ donation by race and ethnicity changed over time in the US?

Findings  In this population-based cohort study, the greatest increases in donation ratios (actual deceased donors to potential donors) were seen in Black and American Indian/Alaska Native populations from 1999 to 2017. Although these increases attenuated racial differences, Black and American Indian/Alaska Native populations still donated at 69% and 28%, respectively, the rate of the White population, and ethnic differences increased over time, with Hispanic/Latino populations having a 4% lower donation ratio than non-Hispanic/Latino populations.

Meaning  Although deceased organ donation among some racial groups increased over time at a faster rate than among the White population, racial differences remain substantial.


Importance  Historically, deceased organ donation was lower among Black compared with White populations, motivating efforts to reduce racial disparities. The overarching effect of these efforts in Black and other racial/ethnic groups remains unclear.

Objective  To examine changes in deceased organ donation over time.

Design, Setting, and Participants  This population-based cohort study used data from January 1, 1999, through December 31, 2017, from the Scientific Registry of Transplant Recipients to quantify the number of actual deceased organ donors, and from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Detailed Mortality File to quantify the number of potential donors (individuals who died under conditions consistent with organ donation). Data were analyzed from December 2, 2019, to May 14, 2020.

Exposures  Race and ethnicity of deceased and potential donors.

Main Outcomes and Measures  For each racial/ethnic group and year, a donation ratio was calculated as the number of actual deceased donors divided by the number of potential donors. Direct age and sex standardization was used to allow for group comparisons, and Poisson regression was used to quantify changes in donation ratio over time.

Results  A total of 141 534 deceased donors and 5 268 200 potential donors were included in the analysis. Among Black individuals, the donation ratio increased 2.58-fold from 1999 to 2017 (yearly change in adjusted incidence rate ratio [aIRR], 1.05; 95% CI, 1.05-1.05; P < .001). This increase was significantly greater than the 1.60-fold increase seen in White individuals. Nevertheless, substantial racial differences remained, with Black individuals still donating at only 69% the rate of White individuals in 2017 (P < .001). Among other racial minority populations, changes were less drastic. Deceased organ donation increased 1.80-fold among American Indian/Alaska Native and 1.40-fold among Asian or Pacific Islander populations, with substantial racial differences remaining in 2017 (American Indian/Alaska Native population donation at 28% and Asian/Pacific Islander population donation at 85% the rate of the White population). Deceased organ donation differences between Hispanic/Latino and non-Hispanic/Latino populations increased over time (4% lower in 2017).

Conclusions and Relevance  The findings of this cohort study suggest that differences in deceased organ donation between White and some racial minority populations have attenuated over time. The greatest gains were observed among Black individuals, who have been the primary targets of study and intervention. Despite improvements, substantial differences remain, suggesting that novel approaches are needed to understand and address relatively lower rates of deceased organ donation among all racial minorities.

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