The authors assessed whether there are racial differences in the rate of liver transplant donors, whether transplant outcomes vary by racial concordance between the donor and the recipient, and whether the rate of diseases that require liver transplant differ by racial groups. Data were obtained for black, white, and Hispanic adult patients undergoing their first liver transplant in a university hospital in Pittsburgh during the period from 1981 to 1988.

There were three main findings:

1. The total number of black donors was well below the number of white donors, and the proportion of black donors was smaller than their population fraction. However the number of black donors was proportional to the number of black recipients. The number of organs donated by the Hispanic population was even smaller than the number donated by the black population.

2. Graft survival rates and patient survival rates for ‘black-donor, white-recipient’ pairs versus ‘white-donor, black-recipient’ pairs were not significantly different. However black recipients had a slight survival disadvantage. There were significant differences noted when the same comparisons were made for ‘Hispanic, non-Hispanic’ pairs. Non-Hispanic white recipients had a large disadvantage in these comparisons.

The authors note that the apparent higher failure rate for organs obtained from white donors and transplanted into black recipients was due to race differences in severity of illness. (This was inferred from their evaluation of UNOS scores for the sub-sample of patients who died.)

Additionally, overall, the survival rates were lowest for black recipients, regardless of the race of the donor. However, the survival rates were lowest when the donor and recipients were of different races when non-Hispanic whites and whites were evaluated. Because of the very small sample sizes, it is unlikely these differences were statistically significant. (Not shown in article.)

Despite the data limitations, the authors conclude that there was no pattern in survival rates associated with racial group mix between donor and recipient. They further concluded that racial differences in survival rates were fully explained by differences in severity.

3. Postnecrotic cirrhosis was the most common disease associated with liver transplant across racial groups. Differences were not observed when the data were stratified by disease categories. However the number of patients, particularly the number of black patients, in each category was too small to draw conclusions from these data.

The authors conclude that, although survival rates did not depend on donor race, because the racial distribution of liver transplant recipients reflected the racial distribution in the donors, a concerted effort must be made to encourage donations from the black and Hispanic populations.