Sex and gender disparity in kidney transplantation: Historical and future perspectives

Abstract

Sex and gender disparity exist in various stages of kidney transplantation. Females were found to be less likely to be referred for kidney transplant, complete pretransplant evaluation, be placed on the waitlist, and receive a kidney transplant compared to their male counterparts. Interestingly, females comprise the majority of living kidney donors. This review explores the biological and psychosocial factors that contribute to sex and gender disparity in kidney transplantation and proposes ways to address the disparity.

The Determinants and Consequences of Living Donor Discussion Direction

“…17 Moreover, research has posited that the overrepresentation of women as living donor may be due to traditional gender norms for women to be more altruistic. 11…”

“…17 Moreover, research has posited that the overrepresentation of women as living donor may be due to traditional gender norms for women to be more altruistic. 11 The main result was that candidate-initiated discussions were more likely to end in negative outcomes. This may be interpreted to mean that while candidates rarely decline evaluation offers, network members who do not volunteer have low rates of willingness to donate.…”

“…For instance, women are more likely to become living kidney donors and less likely to receive donations than men. [7][8][9][10] Although many explanations for this disparity have been offered, 10,11 an understudied factor may be gender differences in altruistic behaviors and gendered caregiving social norms, which could make women more likely to offer to donate, and less likely to accept others' offers, than men. 7,11 Similarly, Black candidates are less likely to receive a living donation than White candidates.…”

“…[7][8][9][10] Although many explanations for this disparity have been offered, 10,11 an understudied factor may be gender differences in altruistic behaviors and gendered caregiving social norms, which could make women more likely to offer to donate, and less likely to accept others' offers, than men. 7,11 Similarly, Black candidates are less likely to receive a living donation than White candidates. 5 Previous research has cited lower levels of LDDs as a contributing factor to racial disparities in LDKT, 6,[12][13][14][15] but no previous research has differentiated these discussions by who initiates them or their consequences for racial disparities.…”

Perspectives of Nephrologists on Gender Disparities in Access to Kidney Transplantation

“…In general, it is estimated that women are 10%-20% less likely to receive kidney transplantation compared with men, with the gap increasing with age. 1 Disproportionately less women are referred for transplantation, waitlisted, or receive a deceased donor kidney transplant than men, and most living kidney donors are women, [2][3][4][5][6] which is compounded further in marginalized groups because of ethnic, sociocultural, education, and financial factors. [7][8][9] Poor access to kidney transplantation among women with kidney failure is associated with worse survival and quality of life.…”