This study aims to characterize racial inequities at each stage of the deceased organ donation process and identify intervention opportunities for organ procurement organizations (OPOs) to facilitate more lifesaving transplants.

We performed a retrospective cohort study using the Organ Retrieval and Collection of Health Information for Donation (ORCHID) database to identify racial inequities across the four stages of the deceased donation process: approach, authorization, procurement, and transplantation. We represented unadjusted estimates as risk ratios with a Wald test to calculate two-sided p-values. Then, we performed nominal logistic regression to produce adjusted odds ratios. Leveraging the model screening function on JMP Pro 17.2, we used a boosted neural network to estimate the main and total effects of model variables on progression to donation.

Whereas the approach, procurement, and transplantation rates are higher among non-white individuals referred for donation, the disproportionately high authorization rate among white donor families creates a racial disparity in transplantation opportunities. The odds of white families being approached is 54% higher than that of non-white families, and the odds of authorizing donation is 3.07 times that of non-white families. However, the boosted neural network reveals that the main and total effects of donor race within an adjusted model are negligible.

Racial disparities in transplantation are primarily attributable to lower authorization rates among non-white donor families. Thus, OPOs must develop culturally competent approach strategies to increase engagement with and education among non-white communities.