 Abstract | | |
Gender discrimination in benefiting from medical treatment is a worldwide problem. Kidney transplantation, as the ideal treatment for patients with end-stage renal disease (ESRD), is not an exception. Considering the unique kidney donation patterns and different family styles in the Middle East, studying this problem in Iran seemed justifiable and necessary. In addition to comparing the numbers of female and male recipients, which has been done in other similar studies, considering the critical effect of waiting time on the outcome, we assessed and compared the waiting times also. The data of age, gender, nationality, donor type and waiting time before transplantation of 1426 (61.85% male, 38.14% female) recipients who underwent transplantation in Imam Reza Hospital in the northeast of Iran from 1990 to 2003, was analyzed. Recipients were categorised into three groups based on donation patterns: those receiving kidney from live unrelated, live related and cadaver donors. The number of patients in each group was 1057 (61.96% male, 38.03% female), 232 (67.24% male, 32.75% female) and 137 (51.82% male, 48.17% female) respectively. The mean overall waiting time was 708 days. Comparing waiting time of male and female recipients in each of these groups did not show significant difference. In all categories of donors, females were less likely than males to be recipients. Furthermore, waiting time for females was longer than males when receiving kidney from sisters and children. For spousal donations, males were recipients more frequently than females although female recipients in this group waited less than their male counterparts to receive the kidney. Generally, our results are in accordance with results of similar researches. In all three mentioned groups, males comprised the majority while the waiting time does not show significant difference between genders. We suggest some reasons for this phenomenon, of which the two main ones are: fewer females are suffering from ESRD and/or females have less chance to find a potential donor in the family, which can be attributed to their lower socio-economic status. Keywords: Kidney Transplantation, Gender disparity
How to cite this article:
Naghibi O, Naghibi M, Nazemian F. Gender Disparity in Kidney Transplantation. Saudi J Kidney Dis Transpl 2008;19:545-50 |
| Introduction | |  |
Renal transplantation is widely considered to be the best form of treatment for patients with end-stage renal disease (ESRD), with a resultant improvement in quality of life as well. [1],[2],[3] Many researches in different parts of the world have shown that there is a huge imbalance between genders while imparting the benefits of renal transplanation. [4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14] Across various groups, including donation from live related donors, live unrelated donors, and spousal donors, males constitute majority of the recipients while females comprise the main donors. Considering the fact that socio-economic patterns in the Middle East are different from their western counterparts, and that this issue has not been looked into in this region, we decided to study whether this imbalance exists in Iran and Afghan patients who were transplanted in northeast of Iran. In addition to gender disparity in donation, knowing that the duration on dialysis prior to transplantation plays a role in the long-term out come of this treatment, [15],[16],[17],[18],[19],[20],[21] we compared the average waiting time before transplantation between males and females in all three various donor types mentioned above. The prevailing pattern of organ donation in Iran is that majority of the donors are voluntary donors comprising mainly living unrelated donors. By analyzing the waiting time for male and female recipients in this category, we can assess their social status in terms of having the chance to be offered these donations.
| Material and Methods | | |
Records of patients who underwent kidney transplantation in centres in northeast of Iran over the period from 1990 to 2003 were reviewed. The following features were recorded: age, gender, nationality, donor type and waiting time before transplantation. For recipients who had second or third transplantation, only details of their first transplantation were recorded. Statistical analyses included descriptive and comparative statistics based on donor source and relationship, gender, age, and donor to recipients gender pairing. P value under 0.05 was considered statistically significant. All analyses were analysed by SPSS.
| Results | | |
A total of 1426 renal transplants were performed at the kidney transplantation centres of the Mashad Medical Science University. As shown in [Table 1], overall, there were 882 male and 544 female recipients whose average duration of wait for renal transplantation, in days, were 694.4 and 730.8 respectively.
Among recipients that received kidney from living unrelated donors, there were 655 males and 402 females whose average duration of wait for renal transplantation, in days, were 699 and 711 respectively [Table 2].
Recipients of kidneys from live related donors amounting to 232 overall, included 156 males and 76 females with average waiting time was 643.3 for males and 663.1 for females [Table 3].
The final group, recipients receiving kidney from cadaver donors (n= 137) comprised of 71 males and 66 females with the waiting period being 762.2 and 925 days respectively [Table 4].
Our study included donation pattern inside families too. In almost all categories, females were less likely than males to be recipients. Furthermore, waiting time for females was longer than males when receiving kidneys from sisters or children. For spousal donations, males were recipients more frequently than females, while female recipients waited less than their male counterparts to receive the kidney [Table 5].
| Discussion | | |
The results of our study are in accordance with results of similar researches in various countries, illustrating disparity between genders in obtaining the benefits of a kidney transplantation. [22]
Iranian patients with ESRD have three potential organ donor sources. They are: living related donors, living unrelated donors and cadaver donors. In the group of recipients who received a kidney from a living related donor, males constituted the majority; however, the waiting time for transplantation does not show significant difference between the genders. This suggests that being a female does not result in a long waiting time although the number of females who have transplantation is fewer. We believe that the two main causes of this observation are: fewer females have ESRD and/or females have less chance to find a donor in the family. The latter is despite the extended family culture that exists in Iran. This implies that the lesser chance of females getting a living related kidney is due to the prevailing social beliefs, which give priority to male members of the family and expect female members to sacrifice.
The next group of recipients is those who received kidneys from live unrelated donors. Obviously, being a member of this group means having enough social power to find a potential donor. The interesting point is that in this group as well, females were in the minority while the waiting time did not show significant difference between genders. We believe it shows that, for the females who have the required social status, there is an equal chance in finding a donor. The last group of recipients comprises patients who received kidney from cadaver donors. Normally, patients with ESRD who do not have the chance of finding a live unrelated donor and do not find a family member to donate his/her kidney are in the waiting list for transplantation from cadaver donors. This group reflects the large number of patients with ESRD who did not have access to living donor kidneys, related or unrelated. The kidney transplantation centres generally give priority to patients in the waiting list having longer waiting time and poorer social status. Furthermore, these recipients had to wait for a longer duration to find a suitable cadaver donor as compared to recipients of living donor kidneys. Another interesting point in this group is that the numbers of male and female recipients are closer when compared to the other groups. Males and females do not need any special social or economic privilege to enter this group, so the difference between males and females decreases.
Overall, there are some ways by which one can decrease the disparity between genders in these three categories. First, impart appropriate education to the general public to give equal care to both genders in the family. With this we can expect that the disparity in the number of males and females who receive kidney from family members will gradually decrease.
Secondly, though some experts suggest decreasing LURD transplantation as a means of raising social justice, we think that if social status of females is increased, for example, by equal education, equal jobs, and governmental supports, females will have increased chance in finding voluntary donors.
The final solution, would be giving priority to females in the waiting list for transplantation from cadaver donors, considering their lower social and economic status, something that is being practiced to some extent in these centres.
| References | | |
| 1. | Evans RW, Manninen DL, Garrison LP Jr. The quality of life of patients with endstage renal disease. N Engl J Med 1985; 312(9):553-9.  |
| 2. | Kutner NG, Brogan D, Kutner MH. Endstage renal disease treatment modality and patients' quality of life longitudinal assessment. Am J Nephrol 1986;6(5):396-402. |
| 3. | Niu SF, Li IC. Quality of life of patients having renal replacement therapy. J Adv Nurs 2005;51(1):15-21. |
| 4. | Khajedehi P. Living non-related versus related renal transplantation: its relationship to the social status, age, and gender of recipients and donors. Nephrol Dial Transplant 1999;14(11):2621-6. |
| 5. | Kjellstrand CM. Age, sex and race inequality in renal transplantation. Arch Intern Med 1988;148(6):1305-9. |
| 6. | Bloembergen WE, Mauger EA, Wolfe RA. Association of gender and access to cadaveric renal transplantation. Am J Kidney Dis 1997;30(6):733-8. |
| 7. | Alexander GC, Sehgal AR. Barriers to cadaveric renal transplantation among blacks, women and the poor. JAMA 1998; 280(13):1148-52. |
| 8. | Zimmerman D, Donnelly S, Miller J. Gender disparity in living renal transplant donation. Am J Kidney Dis 2000;36(3): 534-40. |
| 9. | Schaubel DE, Stewart DE, Morrison HI. Sex inequality in kidney transplantation rates. Arch Intern Med 2000;160(15): 2349-54. |
| 10. | Delano BG, Macey L, Friedman EA. Gender and racial disparity in peritoneal dialysis patients undergoing kidney transplantation. ASAIO J 1997;43(5):M861-4. |
| 11. | Kayler LK, Meier-Kriesche HU, Punch JD. Gender imbalance in living donor renal transplantation. Transplantation 2002;73 (2):248-52. |
| 12. | Oien CM, Reisaeter AV, Leivestad T, Pfeffer P, Fauchald P, Os I. Gender imbalance among donors in living kidney transplantation: the Norwegian experience. Nephrol Dial Transplant 2005;20(4):783-9. |
| 13. | Kayler LK, Rasmussen CS, Dykstra DM, et al. Gender imbalance and outcomes in living donor renal transplantation in the United States. Am J Transplant 2003;3: 452-8. [PUBMED] [FULLTEXT] |
| 14. | Oniscu GC, Schalkwijk AA, Johnson RJ, Brown H, Forsythe JL. Equity of access to renal transplant waiting list and renal transplantation in Scotland: cohort study. BMJ 2003;327(7426):1261. |
| 15. | Goldfarb-Rumyantzev A, Hurdle JF, Scandling J, et al. Duration of end-stage renal disease and kidney transplant outcome. Nephrol Dial Transplant 2005;20 (1):167-75. |
| 16. | Mange KC, Joffe MM, Feldman HI. Dialysis prior to living donor kidney transplantation and rates of acute rejection. Nephrol Dial Transplant 2003;18(1):172- 7. |
| 17. | Maange KC, Joffe MM. Effect of the use or non use of long term dialysis on the subsequent survival of renal transplants from Living donors. N Engl J Med 2001; 344(10):8. |
| 18. | Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation 2002;74(10):1377-81. |
| 19. | Ishitani M, Isaacs R, Norwood V, Nock S, Lobo P. Predictors of graft survival in pediatric living-related kidney transplant recipients. Transplantation 2000;70(2): 288-92. |
| 20. | Gaylin DS, Held PJ, Port FK, Hunsicker LG. The impact of comorbid and socio-demographic factors on access to renal transplantation. JAMA 1993;269(5):603-8. |
| 21. | Meier-Kriesche HU, Port FK, Ojo AO, Rudich SM. Effect of waiting time on renal transplant outcome. Kidney Int 2000;58(3):1311-7. |
| 22. | Jindal RM, Ryan JJ, Sajjad I, Murthy MH, Baines LS. Kidney transplantation and gender disparity. Am J Nephrol 2005;25 (5):474-83. |
Correspondence Address:
Orode Naghibi
No. 62, Niloofar 13, Sajjad Ave., 91878
Iran
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PMID: 18580010 
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5] |
