Purpose: It has been asserted that organ procurement organizations (OPOs) use race and ethnicity to determine whether to respond to referrals and approach families for donation and thereby contribute to transplantation inequity.  These concerns have not yet been addressed with data by OPOs. The purpose of this study was to use a robust electronic donor record that automatically captures all interactions with donor hospitals, including personnel time, to assess whether race is a factor in critical donation processes.

 Methods: 18,685 potential donors referred to OneLegacy (OL) in 2021 & 2022 were reviewed.  Date, time, and duration of staff site visits were automatically captured by cell phone based automated geo-tracking. Hospital referral completeness was validated by regular hospital death record reviews with donor hospitals. Population and hospital discharge demographic data were obtained from publicly available sources and compared with donor referrals. The percentage of on-site assessment of non-contraindicated donors was compared by race.  The percentage by race of non-contraindicated referrals was compared to the percentage approached for authorization. Hours on-site in hospital by family services staff were compared by race.

 Results: Table 1 shows racial characteristics of the seven-county population served by OL, of hospital discharges in the seven counties, and of potential donor referrals.  Non-whites were a disproportionate number of donation referrals compared to hospital discharges. Death record reviews showed negligible not referred cases.

 Table 2 shows the percentage by race of net referrals (excludes cancer, sepsis, age > 75, survived, & died on ventilator and ruled out during phone assessment) that were evaluated on-site, the percentage by race of total approached for authorization compared to net authorizations, and the hours on-site by race of coordinators and family services staff.  Non-whites were evaluated on-site at a higher rate than whites and approached for authorization at a higher rate than whites.  For cases that were approached for authorization more time was spent with non-white families than white families.

 Conclusions:  Hospitals referred potential donors without regard to race.  OneLegacy personnel responded on-site and approached potential donor families to obtain authorization without regard to race.   The only care that was not color blind were conversations with families about donation, where racial, ethnicity, language, and cultural differences regarding death, donor registration, and trust with the health care system require culturally appropriate and trained requesters. 

Given the possible harm done to public trust in donation by recent public discussion on race, OPOs’ reporting their data on racial equity, even if one at a time, would help assure individual and community trust, which are essential for continued improvement.