A Step Toward Bridging the Gender Gap in Deceased Donor Kidney Transplant

Gender disparity in access to kidney transplant is a well-established universal challenge. Prior to 2020, duration on the transplant wait list was the only criterium for deceased donor kidney transplant allocation in the state of Gujarat. In January 2020, the State Organ and Tissue Transplant Organization Gujarat was formed, which implemented a point system for deceased donor kidney transplant allocation policy based on human leukocyte antigen mismatch, panel reactive antibody, and donor-specific antibody, among other factors. In this system, adult female recipients are assigned 2 additional points. We investigated the effect of change in deceased donor kidney transplant allocation policy on disparities between male and female recipients.

This is a retrospective, single-center, observational study. The number of male and female recipients who received deceased donor kidney transplant was collected from the medical records at the nephrology department for the period January 2014 through December 2024. We analyzed trends using logistic regression with inverse variance weighting.

Over the study period, 3814 kidney transplants were conducted, comprising 2732 from living donors and 1083 from deceased donors. We found a progressive increase in the percentage of women who were deceased donor kidney transplant recipients, from 27.57% in 2019 to 50.76% in 2024 (P < .001). This increase may be attributed to the compounding effect of point allocation to the categories of donor-specific antibody, panel reactive antibody, patient age, and gender.

Our study provided new insights for resolution of gaps in deceased donor kidney transplantation between male and female recipients. Implementation of a point-based system for deceased donor kidney transplant allocation policy with extra points for recipients who are women may increase the number of kidney transplants for these recipients. A similar policy may be undertaken by other centers to achieve a temporary solution until underlying factors leading to gender disparity are better understood and methods to overcome these challenges are formed.