Patient and Provider Gender and Kidney Transplant Referral in Canada: A Survey of Canadian Healthcare Providers

Abstract

Background. Referral for kidney transplant (KT) is variable, with women often disadvantaged. This study aimed to better characterize Canadian transplant referral practices and identify potential differences by respondent and/or patient gender using surveys targeted at healthcare practitioners (HCPs) involved in KT. Methods. Surveys consisting of 25 complex patient cases representing 7 themes were distributed to KT HCPs across Canada (March 3, 2022–April 27, 2022) using national nephrology/transplant society email registries. Respondents were asked whether they would refer the patient for transplant. Two identical surveys were created, differing only by gender/gender pronouns used in each case. Multivariable logistic regression was used to assess the association of respondent demographics and patient themes (including case gender) with the odds of transplant referral (overall and stratifying by respondent gender). Results. Overall, the referral rate was 58.0% among 97 survey respondents (46.4% male). Case themes associated with a lower likelihood of referral included adherence concerns (adjusted odds ratio [aOR] 0.65; 95% confidence interval [CI], 0.45-0.94), medical complexity (aOR 0.57; 95% CI, 0.38-0.85), and perceived frailty (aOR 0.63; 95% CI, 0.47-0.84). Respondent gender was not associated with differences in KT referral (aOR 0.91; 95% CI, 0.65-1.26 for male versus female respondents) but modified the association of frailty (less referral for male than female respondents, P = 0.005) and medical complexity (less referral for female than male respondents, P = 0.009) with referral. There were no differences in referral rate by case gender (P = 0.82). Conclusions. KT referral practices vary among Canadian HCPs. In this study, there were no differences in likelihood of transplant referral by candidate gender.

Exploring Potential Gender-Based Disparities in Referral for Transplant, Activation on the Waitlist and Kidney Transplantation in a Canadian Cohort

“… 40 Similarly, information regarding comorbidity severity was lacking, which may also influence decisions regarding transplant eligibility. Although it has been suggested that health care provider gender may influence decision making regarding transplant eligibility according to frailty or medical complexity, 41 the treating physician’s gender was not available for this analysis. This study is 1 of the most granular analyses of gender disparities in access to transplant in that each patient chart was abstracted (blind to gender) to identify the presence of potential contraindications to KT; however, there is still much about physician gestalt and rationale behind nonreferral that was missing from the medical record.…”

Gender Disparities in Access to Kidney Transplantation

“…Interestingly, the Canadian survey study noted that women nephrologists were less likely to refer medically complex patients for transplantation while men nephrologists were less likely to refer frail patients. 8 However, whether these findings translate to clinical practice is unknown.…”

“…From a nephrology perspective, a recent Canadian survey study found that while kidney transplant referral practices varied among health care providers, no differences by candidate gender in likelihood of referral were noted in hypothetical case scenarios. 8 While we are not aware of studies specific to nephrology examining whether patient experiences or outcomes differ related to physician-patient gender concordance, it is worth noting that roughly equal numbers of women and men nephrologists were included as part of the present study, although the gender of the nephrologist was not accounted for in the analysis of results. Interestingly, the Canadian survey study noted that women nephrologists were less likely to refer medically complex patients for transplantation while men nephrologists were less likely to refer frail patients.…”