Exploring the gender gap in living kidney donation and transplantation- a regional perspective from Punjab, Pakistan

Gender disparity remains a significant challenge affecting organ donation and transplantation, as approximately 60% of living kidney transplants performed worldwide involve female donors. There is limited information available on gender disparities in organ donation and transplantation in Pakistan. This study aimed to evaluate gender disparities in living kidney donation and transplantation in Punjab. Pakistan. Multicenter secondary data on living kidney recipients and their donors collected from hospitals registered with the Punjab Human Organ Transplantation Authority (PHOTA) were analyzed to explore the gender disparities in living kidney donation and transplantation in Punjab, Pakistan. The outcome of interest was the probability of males (in comparison to females) and females (in contrast to males) receiving and donating a kidney to a genetically unrelated person among 417 eligible living kidney transplant recipients and their donors. Four hundred ninety-two kidney transplants were performed in Punjab province from January 01 to December 31, 2021, whereas 417 kidney transplant recipients and donors were included in the study. The majority (87.3%) of kidney transplant recipients were male, whereas only 12.7% of kidney transplant recipients were females. In contrast, 59.7% of kidney donors were female, and only 40.3% were males. More than half of the donor-recipient pairs were genetically related (66.2%) and reported to be siblings (45.8%), followed by others (cousins, aunts, nieces, and nephews) (17.3%) and spouses (16.3%). Females were 13.02 times more likely to donate a kidney to their husbands. Still, their husbands were 0.08 times less likely to donate a kidney to their wives, indicating that males are more inclined to donate a kidney to their offspring, siblings, and other social relationships. At the same time, females are less likely to donate a kidney to their offspring and other social relationships. Our current study elaborates on the existing sex-based disparities in living kidney donation and transplantation in Punjab, Pakistan, as males dominate the recipient pool and females are living donors. It is imperative to develop and deploy strategies to ensure equitable access to living donor kidney transplantation, regardless of sex.