1. A co- nephrology fellow recently explored gender-based health disparities in kidney transplantation rates in the United States. Several observational analyses of patients with end-stage renal disease revealed that women, when compared to men, were less likely to be referred for transplant evaluation and experienced a longer wait time after being evaluated. Several biologic differences were initially posited; for example, some thought that the longer wait time was due to greater alloimmunity among women who had been pregnant during their lifetime. However, alloimmunity scores alone could not fully account for the difference in rates (and certainly not why women were referred less frequently for transplant evaluation). Are these differences due to biases that impact a physician’s decision to refer his/her female patient? Is there a gap in knowledge (or even a difference in belief) about transplantation among women? Identifying the factors that lead to this gender-based disparity, and where they lie along the socioecological framework, may help target interventions to close this gap.
2. As examples of a structural determinants of disparity, differences in access to disposable income (structural) between men and women may lead to differences in feelings of whether patients can afford the downstream costs that associated with transplantation. A second difference may be due to the American society viewpoint that women are the primary caregivers to children (structural). Familial obligations may limit the ability to attend all the examinations and testing that are required for clearance. A third potential example is a psychosocial (intermediary) factor. Women may have limited views of their “worthiness” for a transplant and may feel more uncomfortable than men asking family and friends to become living donors. Gender based disparities due to societal norms may function intergenerationally if these cultural beliefs are passed from parents to their children.