Sex and Gender Disparities in Kidney Transplantation

Abstract

Sex refers to biological traits, while gender involves socially constructed roles and behaviors. Globally, women face disparities in access to kidney transplants, and outcomes, driven by sociocultural and systemic factors. Females have a higher prevalence of kidney disease, start dialysis at lower glomerular filtration rates, and receive lower dialysis doses than males. Fewer females are refered for kidney transplants than males, and females have lower rates of preemptive transplantation than males. There are significant disparities in waitlisting, with fewer females being placed on kidney transplant waiting list and females having longer median wait time, as compared to males. Studies indicate variable outcomes in kidney allograft survival in males and females due to differences in immune response, hormonal effects, and nephron mismatch. Socioeconomic, cultural, and psychosocial factors exacerbate these gaps, alongside healthcare provider biases. Females constitute over 75% of donors, often reflecting caregiving roles. Addressing these disparities requires equitable organ allocation systems, strengthened donor exchange programs, financial support, and culturally sensitive education. Research and policy reforms remain critical to bridging the sex and gender gap in kidney transplantation.