HMN 2026: What is the gender gap in kidney transplant referrals

Female patients with kidney failure are significantly less likely to be referred to a transplant center for assessment, according to a new study from ICES, London Health Sciences Center Research Institute (LHSCRI) and Western University. The disadvantage widened with increasing age. The findings were published in the May issue of the Canadian Journal of Kidney Health and Disease.

“Despite universal access to health care, females are disadvantaged in reaching the first step toward receiving a kidney transplant,” said Kyla Naylor, professor of epidemiology and biostatistics at Schulich School of Medicine & Dentistry and a scientist at ICES and LHSCRI. “We should be monitoring access to kidney transplantation across diverse demographic groups to better understand the barriers people face and design interventions that effectively address these barriers.”

The study included 17,993 patients diagnosed with kidney failure between 2017 and 2021, of whom 61.6% were male and 38.4% were female.

Females were 14% less likely to be referred to a transplant center for assessment compared with males. The lower referral rate means 9.35 females were referred per 100 person-years, compared with 10.91 among men. The rate of referral was even lower for patients receiving maintenance dialysis.

This disadvantage female individuals faced in referral for transplant assessment worsened with age. Female patients ages 65 to 75 were 27% less likely to be referred. No significant differences were observed between males and females at other steps in the transplant process.

“Although the underlying causes of these discrepancies are not yet fully understood, integrating equity-focused approaches into kidney care planning and reporting will help close gaps and advance chronic kidney disease care overall,” said Naylor.

The researchers suggest that sex-based barriers, such as lower self-advocacy and implicit biases, may affect kidney transplant processes.

They explained that older females, even when comparable in age and health to their male peers, may be viewed as more frail, leading to perceptions that they are less suitable candidates for transplantation.

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