Persistent Gender Disparity in Kidney Transplantation: A Call for Equity

To the Editor, Optimal treatment for end stage kidney disease still remains kidney transplantation, yet the pathway to becoming a recipient or donor appears to differ significantly by gender. We present the data from a single-center study over more than a decade, which reveals a consistently skewed distribution in both recipients and donors by gender-raising important questions about systemic disparity. Our analysis of 310 renal transplant recipients [Figure 1.1 and 1.2] shows that male recipients vastly outnumber female recipients throughout the years studied (2012–2024). On average, only 15%–20% of kidney transplant recipients were female, a trend that remained unchanged over time (nptrend P = 0.737). Despite increasing awareness and healthcare reforms, the proportion of female recipients has not significantly improved, as visualized in the year-wise distribution and proportional bar charts.Figure 1: Snapshot of the trend. 1.1, and 1.2 are KT living recipient numbers and percentage over the years. 1.3 and 1.4 are living donor who donated as numbers and percentage over the yearsIn contrast, the analysis of kidney donors (n = 310) highlights a reversed disparity. Females contributed disproportionately to kidney donation (60%–70% annually), with this pattern remaining statistically unchanged across time (nptrend P = 0.385), as shown in Figure 1.3 and 1.4. This implies a persistent cultural or psychosocial expectation for women to serve as donors, while not being equally prioritized as recipients. This dual disparity is evident not just in absolute numbers but also when stratified by the Marginal Propensity Index (MPI) for both donors and recipients. Female recipients were underrepresented across all MPI strata, while female donors dominated across all risk categories further reinforcing the systemic imbalance. The causes behind this dichotomy are likely multifactorial. Cultural norms, family dynamics, economic barriers, healthcare access inequity, and potential provider biases may contribute to women being less likely to be referred for or listed for transplantation. In addition, altruistic family pressure might be driving higher female donation rates, especially in spousal and parental roles. Notably, our findings mirror trends seen in larger, multinational registries, suggesting this is not an isolated observation.[1-3] However, the persistence of these disparities over time – despite progress in other areas of transplant medicine – is troubling. These findings call for an urgent reevaluation of transplant referral practices, public awareness strategies, and equitable health policies. Gender-sensitive education, unbiased referral algorithms, and monitoring of transplant program metrics stratified by gender may help address this inequality. In conclusion, our study underscores the need for active efforts to correct gender disparities in kidney transplantation. Women continue to give more and receive less in the transplant landscape – a gap that, if left unchecked, undermines the very principles of equity and justice in healthcare. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.