Friday, November 08, 2019

Women's Health News (1): Who Gets The Kidneys?

A presentation* at the recent meeting of the American Society of Nephrology looks at live donor kidney (LDK) transplants in men and women and finds that women are considerably less likely to receive a kidney from a live donor than men:

Among 106,260 primary adult LDK transplants reported to the United Network for Organ Sharing/Organ Procurement and Transplantation Network from 1998 to 2018, the overall rate of LDK transplantation was 38.9% for women and 61.1% for men
The findings show all sorts of odd patterns.  For instance, women were less likely to receive a kidney from an unrelated donor than men, white women were less likely to receive a donated kidney than black women and other women of color, and women who were sensitized were actually more likely to receive a LDK than women who were not.  Sensitized patients are expected to have to wait longer for a transplant, in general.

The author of the presentation suggests that these results are more likely to be caused by varying practice patterns than by underlying sex differences in the disease etiology.

That presentation made me Google stuff about sex and gender differences (two different things here**) in kidney disease, and I found a recently published paper using European data  which shows clear sex differences in the likelihood that a kidney patient receives a transplant.  The relevant percentages are sixty for men and forty for women in that study. 

The difference could be explained by a combination of reasons.  Maybe the disease advances more slowly in women, maybe women are more likely to choose conservative treatments and men transplantation etc.  But we cannot rule out the possibility that access to donated kidneys might be different for men and women.

That some social forces do influence who donates live kidneys and who receives them is suggested by the authors of this study, too:

Perhaps more importantly, this finding also needs to be viewed in the context of women being more likely to donate a kidney to their spouse. This hypothesis is supported by a single center study from Canada, where more than a third of the wives who were acceptable donors went on to donate a kidney to their spouse, compared with 6.5% of husbands (36).
Other studies support the finding that women are more likely to donate kidneys than men and less likely to receive them. Why would that be the case? 

Outright or at least unconscious sexism in those who allocate, say, cadaver kidneys to their final recipients could explain some of the differences in who receives kidneys,but simple financial reasons might be more important:

Socioeconomic factors undoubtedly play a role in the inequality of transplantation between sexes, especially in low- and middle-income countries and regions.Generally, men provide the major income for their family, which may discourage them from donating kidneys. Different employment status and incomes between the sexes may contribute to sex differences in transplantation because employment and income status are usually associated with better health care insurance that cover the costs for transplantation.

Those reasons would have their roots in the traditional gendered division of labor which dictates the male breadwinner model and tends to result in lower average lifetime incomes for women.  But the way the health care system interacts with men and women may also play a role here:

Other reports describe disparities in age and sex in access to kidney transplantation, which originate at the time of pre-referral discussions about kidney transplantation; irrespective of age, women were more likely not to have had discussions with medical professionals.
Did you find this post boring?  I tried to figure out why I wanted to write it (other than the fact that Echidne sounds like "a kidney") without having reached that fairly advanced stage in research where things become simpler to explain, and I realized that was the reason!  Before one gets to that all-is-simple stage in studying something, the real fuzziness and complications are more evident.

This post, for instance, shows the way different explanations (biological, social, cultural) can all play a role in the final conclusions, but might wound together like a rope.  If we wish to find out how sexism and traditional gender roles affect the observed discrepancies, we need to fray that rope and look at only some of its strands while remembering that they are only some strands in the rope.

*  I haven't read the presentation, only the linked summary.  Keep in mind that this is not a published peer-reviewed article, so some caution is advised.  I picked it for this post because that's where I first read about existing and large sex differences in the treatment of kidney disease.

** Sex differences in this context mean any differences between male and female patients in the etiology of the disease, the ease with which it is properly diagnosed and in any associated co-morbidities.

Gender differences would be about differences created by the socially constructed gender norms and roles which are regarded as appropriate for either men or women. 

Gender and sex differences are here assumed to apply (and probably do apply) to the same individuals, i.e. gender is assumed to be defined by one's apparent biological sex.