Perspectives of Transplant Professionals on Gender Differences in Living Kidney Donation.

Introduction: Gender disparities in living kidney donation are well-documented, with women comprising 55% to 65% of kidney donors globally. The underlying reasons for these disparities are multifaceted and complex. We aimed to describe the perspectives of transplant professionals on gender disparities in living kidney donation. Methods: We conducted semistructured interviews with transplant professionals involved in living kidney donation from November 2023 to July 2024. The transcripts were analyzed thematically. Results: Thirty-nine transplant professionals (24 nephrologists [62%], 11 coordinators [28%], 4 transplant surgeons [10%]) from 15 countries participated. We identified the following 5 themes: (i) fulfilling the central role of caregiving (natural extension of the duty of care, prioritizing family health over themselves, empathizing with suffering, and disproportionate burden of childcare); (ii) diminishing autonomy and disempowerment of women (family and societal expectations of women to donate, lack of personal decisional power, and devalued role of women); (iii) driven by courage and vitality (proactivity and health-consciousness, stoicism and resilience through pain); (iv) protecting health outcomes (medical barriers precluding donation in men, preventing risks in future pregnancies); and (v) constrained by financial and health care systems (safeguarding financial wellbeing, fragmented donation pathways, and untold benefits of donation from men). Transplant professionals provided practical strategies to improve living donation among men to reduce the gender gap. Conclusion: Transplant professionals believe that culturally driven societal roles and status of women, the financial burden associated with donation, and concerns about donor health outcomes contribute to gender disparities in living kidney donation.