Vilayur Eswari, van Zwieten Anita, Chen Mingxing, Francis Anna, Wyld Melanie, Kim Siah, Cooper Tess, Wong Germaine
John Hunter Hospital, Hunter New England Health Service, New Lambton, NSW, Australia.
Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia.
Transplant Direct. 2023 Aug 24;9(9):e1530. doi: 10.1097/TXD.0000000000001530. eCollection 2023 Sep.
Women are more likely than men to be living kidney donors. We summarized the evidence concerning the reasons behind sex and gender disparities in living kidney donation (LKD).
A scoping review of quantitative and qualitative evidence on reasons for sex and gender disparities in LKD was conducted from inception to March 2023.
Of 1123 studies screened, 45 were eligible for inclusion. Most studies were from North America, Europe, and Central Asia (n = 33, 73%). A predominance of women as living donors (55%-65%) was observed in 15 out of 18 (83%) studies. Reasons for sex and gender disparities in LKD included socioeconomic, biological, and cognitive or emotional factors. A gendered division of roles within the families was observed in most studies, with men being the primary income earner and women being the main caregiver. Fear of loss of income was a barrier to male donation. Human leukocyte antigen sensitization through pregnancy in female recipients precluded male partner donation, whereas female donation was supported by altruism and a positive attitude toward LKD.
Sex imbalance in LKD is prevalent, with a predominance of women as living donors. Such disparities are driven by societal and cultural perceptions of gender roles, pregnancy-induced sensitization, and attitudes toward donation and at least some of these factors are modifiable. Donor compensation to support predonation assessments and income loss, implementation of innovative desensitization treatments, promotion of paired kidney exchange program, and targeted educational initiatives to promote equitable living donation may help to close the gender gap in LKD.
女性比男性更有可能成为活体肾供体。我们总结了有关活体肾捐赠（LKD）中性别差异背后原因的证据。
对从开始到2023年3月有关LKD中性别差异原因的定量和定性证据进行了范围综述。
在筛选的1123项研究中，45项符合纳入标准。大多数研究来自北美、欧洲和中亚（n = 33，73%）。在18项研究中的15项（83%）中观察到女性作为活体供体占主导（55%-65%）。LKD中性别差异的原因包括社会经济、生物学以及认知或情感因素。在大多数研究中观察到家庭内部存在性别角色分工，男性是主要收入者，女性是主要照顾者。对收入损失的担忧是男性捐赠的一个障碍。女性受者因怀孕导致的人类白细胞抗原致敏使男性伴侣无法捐赠，而女性捐赠则受到利他主义和对LKD的积极态度的支持。
LKD中的性别失衡普遍存在，女性作为活体供体占主导。这种差异是由社会和文化对性别角色的认知、怀孕引起的致敏以及对捐赠的态度驱动的，并且这些因素中的至少一些是可以改变的。提供捐赠补偿以支持捐赠前评估和收入损失、实施创新的脱敏治疗、推广配对肾交换计划以及开展有针对性的教育举措以促进公平的活体捐赠，可能有助于缩小LKD中的性别差距。
