Kidney failure is a devastating condition and there are never enough donors for recipients - so it seems strange that anyone would be hesitant about getting one, but a new paper in the Clinical Journal of the American Society of Nephrology suggest that interventions are needed to increase women's acceptance of living donor kidney transplantation.

Recent research into disparities in acceptance has focused primarily at the transplant clinic level, but disparities might be underestimated when only patients undergoing transplant evaluations are studied. For this reason, Avrum Gillespie, MD, of Temple University School of Medicine, and colleagues looked for disparities in dialysis clinics and included patients both potentially eligible and ineligible for receiving a transplant.

Some of the counterintuitive findings were that, among black kidney failure patients undergoing dialysis, women were much less likely than men to want to receive kidney transplants from living donors, despite more offers from family and friends.

The research team administered a transplant questionnaire to 116 patients in two urban, predominantly black hemodialysis units. Among the major findings:

• Women were less likely to want to undergo living donor kidney transplantation compared with men (58.5% vs 87.5%) despite being nearly twice as likely as men to receive unsolicited offers for kidney transplants from family and friends (73.2% vs 43.2%).

• Women were also less likely to have been evaluated for a kidney transplant (28.3% vs 52.2%).
• After controlling for various factors known to influence transplant decisions, women were 87% less likely to want to undergo living donor kidney transplantation than men.

Accounting for that is difficult. Do women see it as a burden on others and are less likely to want to impose on family and friends? The survey did not try and delve into that, though clearly that level of understanding has to be part of the solution.

"To help improve the gender disparities in living donor kidney transplantation, future work is needed to learn how to support and encourage women to accept transplants," said Dr. Gillespie.