Disparities in access to living donor kidney transplantation

Living donor kidney transplantation (LDKT) provides superior outcomes compared to deceased donor kidney transplantation (DDKT), yet significant disparities persist in access and utilization across demographic groups in the United States. This review synthesizes current evidence on racial, socioeconomic, and geographic barriers affecting LDKT access.

Racial disparities remain substantial; white patients are most likely to receive LDKT, while black and Hispanic populations face lower referral, evaluation, and donation rates. Socioeconomic status further compounds disparities, with higher income and privately insured candidates enjoying greater LDKT access. Financial burdens for donors, including lost wages and donation expenses, are insufficiently offset by policies to date. Geographic variation in LDKT mirrors differences in access to transplant centers, with disadvantaged neighborhoods and low-volume centers contributing to reduced LDKT rates. Center-level practices, state policies, and distance to care all play critical roles.

As disparities in LDKT persist or worsen, achieving equity requires coordinated intervention across patient, provider, institutional, and policy levels, centered on dismantling structural barriers and meeting the goals established by national transplant initiatives. Addressing these factors is essential for ensuring just and equitable access to LDKT for all patients.