Gender Disparity in Asian-Pacific Countries: An Analysis of the ASTREG-WIT-KT Registry

Wong, Germaine; Kute, Vivek; Nakagawa, Yuki; Wang, Hsu-Han; Arakama, Mel Hatra; Jeong, Jong Cheol; Cho, Yun Yung; Thwin, Khin Thida; Chapman, Jeremy; Sapir‐Pichhadze, Ruth; Mannon, Roslyn B.; Ahn, Curie; Kim, Yeong Hoon

doi:10.1097/tp.0000000000004223

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…Root causes for the inequities may also differ between regions and countries. In countries such as India and Bangladesh, >70% of the living donors are women, and such disparities are driven largely by cultural and patriarchal norms 16 , whereas in countries such as the Philippines 16 and Iran, 17 financial drivers may be responsible for the observed disparity. 8 Current observational data highlights the prevalence and magnitude of the existing sex and gender disparities in living kidney donation, but a comprehensive review evaluating the reasons behind this disparity across many settings is lacking.…”

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Sex and Gender Disparities in Living Kidney Donation: A Scoping Review

Vilayur,

van Zwieten,

Chen

et al. 2023

Transplantation Direct

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Background. Women are more likely than men to be living kidney donors. We summarized the evidence concerning the reasons behind sex and gender disparities in living kidney donation (LKD). Methods. A scoping review of quantitative and qualitative evidence on reasons for sex and gender disparities in LKD was conducted from inception to March 2023. Results. Of 1123 studies screened, 45 were eligible for inclusion. Most studies were from North America, Europe, and Central Asia (n = 33, 73%). A predominance of women as living donors (55%–65%) was observed in 15 out of 18 (83%) studies. Reasons for sex and gender disparities in LKD included socioeconomic, biological, and cognitive or emotional factors. A gendered division of roles within the families was observed in most studies, with men being the primary income earner and women being the main caregiver. Fear of loss of income was a barrier to male donation. Human leukocyte antigen sensitization through pregnancy in female recipients precluded male partner donation, whereas female donation was supported by altruism and a positive attitude toward LKD. Conclusions. Sex imbalance in LKD is prevalent, with a predominance of women as living donors. Such disparities are driven by societal and cultural perceptions of gender roles, pregnancy-induced sensitization, and attitudes toward donation and at least some of these factors are modifiable. Donor compensation to support predonation assessments and income loss, implementation of innovative desensitization treatments, promotion of paired kidney exchange program, and targeted educational initiatives to promote equitable living donation may help to close the gender gap in LKD.

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Sex and Gender Disparities in Living Kidney Donation: A Scoping Review

Vilayur,

van Zwieten,

Chen

et al. 2023

Transplantation Direct

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“…Asia has proportionately less female DDKT recipients; indicating gender inequality in access to KRT. 55 The diverse racial heterogeneity of the Asian population also means that any policy direction must incorporate the viewpoints and buy-in potential of the different ethnic and cultural subgroups of the population. Cultural adaptations must be made to allow changes to procurement protocol.…”

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confidence: 99%

Deceased donor kidney transplant policies in Asia – implications on practice and recommendations for the future

Tan,

Mabood Khalil,

Kee

et al. 2024

The Lancet Regional Health - Southeast Asia

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Impact of single centre kidney‐exchange transplantation to increase living donor pool in India: A cohort study involving non‐anonymous allocation

Kute,

Patel,

Banerjee

et al. 2024

Nephrology

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AimIn India, 85% of organ donations are from living donors and 15% are from deceased donors. One‐third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost‐effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%–35%.MethodsWe report our experience with 539 KET cases and the evolution of a single‐centre program to increase the use of LDKT.ResultsBetween January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2‐way (n = 2 × 202 = 404), 16.2% 3‐way (n = 3 × 29 = 87), 3% 4‐way (n = 4 × 4 = 16), 1.8% 5‐way (n = 5 × 2 = 10), 2.2% 6‐way (n = 6 × 2 = 12), and 1.8% 10‐way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow‐up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high‐volume LDKT programs, non‐anonymous allocation and teamwork.ConclusionThis is the largest single‐centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs.image

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Gender Disparity in Asian-Pacific Countries: An Analysis of the ASTREG-WIT-KT Registry

Cited by 4 publications

References 27 publications

Sex and Gender Disparities in Living Kidney Donation: A Scoping Review

Sex and Gender Disparities in Living Kidney Donation: A Scoping Review

Deceased donor kidney transplant policies in Asia – implications on practice and recommendations for the future

Impact of single centre kidney‐exchange transplantation to increase living donor pool in India: A cohort study involving non‐anonymous allocation

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