Gender Disparity in Living Kidney Transplantation: A Comparison of Global, Mid-European and German Data and their Ethical Relevance

Aim/Background: The gender-disparity hypothesis for living kidney transplantation describes the empirical observation that women donate kidneys more frequently than men, but fewer women than men receive organs (1). The aims of our investigation were a) the quantitative verification of the gender-disparity-hypothesis in different countries and esp. in Germany, and b) the qualitative and ethical analysis of possible causes. Material/Methods: Our analysis is based upon recent data provided by DSO, Eurotransplant, and UK-Transplant for 2002-2004, and a qualitative review of published studies. On the basis of these datasets, we analysed the gender-disparity hypothesis at two levels: a) in different countries and in different years, and b) on different organisational levels in Germany (regions, family structures). Results: Our results broadly support the gender-disparity-hypothesis. A) Significant variations in the gender-ratios could be found in a comparison between Germany, USA, Switzerland, Norway, Iran and Great Britain. In Eurotransplant-countries, significant variations in gender-ratios over the years were only found in Austria (Donors c2(2)=6.62; p<0.05; Receivers: c2(2)=5.21; p=0.074). B) In Germany, there is a significant difference between expected and observed numbers of women serving as donors in 6 out of 7 DSO regions. For spouses (33.3% of all living kidney donors) and siblings, there is a significant tendency supporting the gender-disparity-hypothesis, insofar as more women donate kidneys to their husbands (c2(1)=2.78; p<0.05) and brothers (c2(1) = 2.74; p<0.05) than vice versa. Parents are the largest group of living donors (61.2%). In this group, fathers donate significantly less often and mothers more often to their children than one would expect according to the epidemiological data (c2(1) = 36.8; p<0.000000005). Discussion: The differences between the number of women and men serving as organ donors and organ receivers pose important ethical and practical questions concerning gender related motivations, gender roles, and socio-economic factors. Our results stress the need for further interdisciplinary studies on the causalities to provide solutions for better information strategies and the counselling process of potential donors and receivers.