Disparities in Heart Transplantation Allocation and Outcomes by Blood Type in Korea (2010–2022)

Background and Objectives: This study aimed to elucidate the influence of recipient blood type on heart transplant allocation dynamics in Korea, focusing on donor matching, wait times, and post-transplant survival from 2010 to 2022. Methods: In this retrospective cohort study, we examined 1,745 heart transplant recipients classified by blood types: A (n=631), B (n=488), AB (n=256), and O (n=370). Parameters studied encompassed donor and recipient ages, donor blood type compatibility, organ type, emergency status, waiting periods, and survival rates up to one year post-transplant. Results: This investigation revealed significant disparities in the outcomes for heart transplant waitlist patients, differentiated by blood type. O recipients encountered notably extended median wait times of 110 days (an average of 300±514 days), which is substantially longer compared to A (65 days), B (58 days), and AB (29 days). Furthermore, the mortality rate for O recipients while on the waitlist was markedly high at 78.1%, in contrast to 75.2% for A, 72.3% for B, and 48.5% for AB. O recipients who, despite constituting a significant proportion of the donor pool (34.1%), received transplants at disproportionately lower rates. Conclusions: Type O heart transplant recipients in Korea face significant challenges, including higher mortality rates during the waiting period and frequent necessity for left ventricular assist device interventions. Urgent policy reforms are needed to address these disparities and improve equitable organ allocation for blood type O patients.