Intersectional race and gender disparities in kidney transplant access in the United States: a scoping review

Background Gender and racial disparities in kidney transplant access are well established, however how gender and race interact to shape access to kidney transplant is less clear. Therefore, we examined existing literature to assess what is known about the potential interaction of gender and race and the impact on access to kidney transplantation in the US. Methods Following PRISMA guidelines, we conducted a scoping review and included quantitative and qualitative studies published in English between 1990 and May 31, 2023 among adult end-stage kidney disease patients in the US. All studies reported on access to specific transplant steps or perceived barriers to transplant access in gender and race subgroups, and the intersection between the two. We narratively synthesized findings across studies. Results Fourteen studies met inclusion criteria and included outcomes of referral ( n = 4, 29%), evaluation ( n = 2, 14%), waitlisting ( n = 4, 29%), transplantation ( n = 5, 36%), provider perceptions of patient transplant candidacy ( n = 3, 21%), and patient preferences and requests for a living donor ( n = 5, 36%). Overall, we found that White men have the greatest access at all steps of the transplant process, from referral to eventual living or deceased donor transplantation. In contrast, women from racial or ethnic minorities tend to have the lowest access to kidney transplant, in particular living donor transplant, though this was not consistent across all studies. Conclusions Examining how racism and sexism interact to shape kidney transplant access should be investigated in future research, in order to ultimately shape policies and interventions to improve equity.