Skip to main content

Gender imbalance in living organ donation

Abstract

Living organ donation has developed into an important therapeutic option in transplantation medicine. However, there are some medico-ethical problems that come along with the increasing reliance on this organ source. One of these concerns is based on the observation that many more women than men function as living organ donors. Whereas discrimination and differential access have been extensively discussed in the context of cadaveric transplantation and other areas of health care, the issue of gender imbalance in living organ donation has received less attention. This paper presents relevant data from the Eurotransplant and UNOS transplantation systems and discusses possible explanations for the documented gender discrepancies. The conclusion calls for are view of existing practice guidelines in order to secure effective protection of particularly vulnerable potential donors and an equitable donor-recipient-ratio in living organ donation.

This is a preview of subscription content, access via your institution.

References

  • Alexander, G.C. and A.R. Sehgal: 1998, 'Barriers to Cadaveric Renal Transplantation Among Blacks, Women, and the Poor', Journal of the American Medical Association 280, 1148–1152.

    PubMed  CAS  Article  Google Scholar 

  • Baker, R.: 1993, 'Visibility and the Just Allocation of Health Care: A Study of Age Rationing in the British National Health Service', Health Care Analysis 1, 139–150.

    PubMed  CAS  Article  Google Scholar 

  • Bloembergen, W.E., F.K. Port, E.A. Mauger, J.P. Briggs and A.B. Leichtman: 1996, 'Gender discrepancies in living related renal transplant donors and recipients', Journal of the American Society of Nephrology 7, 1139–1144.

    PubMed  CAS  Google Scholar 

  • Council on Ethical and Judicial Affairs of the American Medical Association: 1991, 'Gender Disparities in Clinical Decision Making', Journal of the American Medical Association 266, 559–562.

    Article  Google Scholar 

  • Donnelley, P.K. and D. Price (eds.): 1997, Questioning Attitudes to Living Donor Transplantation. European Multicenter Study Transplantation of Organs from Living Donors-Ethical and Legal Dimensions. Leicester: EUROTOLD.

    Google Scholar 

  • Dossetor, J.B.: 1995, 'Economic, Social, Racial and Age-Related Considerations in Dialysis and Transplantation', Current Opinion in Nephrology and Hypertension 4, 498–501.

    PubMed  CAS  Google Scholar 

  • Ellison, M.D., T.J. Breen, F. Glascock, L.J. McGaw and O.P. Daily: 1992, 'Organ Donation in the United States: 1988 Through 1991', Clinical Transplantation, 119–128.

  • Eurotransplant: 1999, Annual report 1998. Leiden: Eurotransplant.

    Google Scholar 

  • Filligim, R.B. (ed.): 2000, Sex, Gender, and Pain. Progress in Pain Research and Management, Vol. 17. Seattle, WA: IASP Press.

    Google Scholar 

  • Gilligan, C.: 1982, In a Different Voice: Psychological Theory and Women's Development.Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Gilligan, C.: 1987, 'Moral Orientation and Moral Development', in: E.F. Kittay and D.T. Meyers (eds.), Women and Moral Theory. Totowa, New Jersey: Roman and Littlefield, pp. 19–33.

    Google Scholar 

  • Goldman, M.B. and M.C. Hatch (eds.): 2000, Women and Health.San Diego, CA: Academic Press.

    Google Scholar 

  • Greenberger, P.: 1998, 'News from the Society for the Advancement of Women's Health Research. What Works for Women: Outcomes Research', Journal of Women's Health 7, 11–14.

    PubMed  CAS  Article  Google Scholar 

  • Harper, A.M., J.D. Rosendale, M.A. McBride, W.S. Cherikh and M.D. Ellison: 1998, 'The UNOS OPTNWaiting List and Donor Registry', Clinical Transplantation, 73–90.

  • Harper, A.M. and J.D. Rosendale: 1996, 'The UNOS OPTN Waiting List and Donor Registry: 1988–1996', Clinical Transplantation, 69–90.

  • Johnson, E.M., J.S. Najarian and A.J. Matas: 1997a, 'Living Kidney Donation: Donor Risks and Quality of Life', Clinical Transplantation, 231–240.

  • Johnson, E.M., M.J. Remucal, K.J. Gillingham, R.A. Dahms, J.S. Najarian and A.J. Matas: 1997b, 'Complications and Risks of Living Donor Nephrectomy', Transplantation 64, 1124–1128.

    PubMed  CAS  Article  Google Scholar 

  • Kasten, H.: 1980, 'Entwicklung und Erprobung einer Altruismus-Beobachtungs-Systems', Gruppendynamik 11, 17–24.

    Google Scholar 

  • Kjellstrand, C.M.: 1988, 'Age, Sex, and Race Inequality in Renal Transplantation', Archives of Internal Medicine 148, 1305–1309.

    PubMed  CAS  Article  Google Scholar 

  • Levinsky, N.G.: 2000, 'Organ Donation by Unrelated Donors', New England Journal of Medicine 343, 430–432.

    PubMed  CAS  Article  Google Scholar 

  • Mastrioianni, A.C., R. Faden and D. Federman (eds.): 1994, Women and Health Research. Ethical and Legal Issues of Including Women in Clinical Studies. Vol. 1 and 2. Washington, DC: National Academy Press.

    Google Scholar 

  • Monroe, K.R.: 1996, The Heart of Altruism. Perceptions of a Common Humanity.Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Nicholson, M.L. and J.A. Bradley: 1999, 'Renal Transplantation from Living Donors', British Medical Journal 318, 409–410.

    PubMed  CAS  Google Scholar 

  • Noddings, N.: 1984, Caring: A Feminine Approach to Ethics and Moral Education.Berkeley: University of California Press.

    Google Scholar 

  • Ojo, A. and F.K. Port: 1993, 'Influence of Race and Gender on Related Donor Renal Transplantation Rates', American Journal of Kidney Diseases 22, 835–841.

    PubMed  CAS  Google Scholar 

  • Ruddick, S.: 1989, Maternal Thinking. Toward a Politics of Peace.Boston: Beacon Press.

    Google Scholar 

  • Rushton, J.P., D.W. Fulker, M.C. Neale, D.K. Nias and H.J. Eysenck: 1986, 'Altruism and Aggression: The Heritability of Individual Differences', Journal of Personality and Social Psychology 50, 1192–1198.

    PubMed  CAS  Article  Google Scholar 

  • Russell G.W. and R.K. Mentzel: 1990, 'Sympathy and Altruism in Response to Disasters', The Journal of social psychology 130, 309–316.

    PubMed  CAS  Article  Google Scholar 

  • Schover, L.R., S.B. Streem, N. Boparai, K. Duriak and A.C. Novick: 1997, 'The Psychosocial Impact of Donating a Kidney: Long-Term Follow-up from a Urology Based Center', Journal of Urology 157, 1596–1601.

    PubMed  CAS  Article  Google Scholar 

  • Simmons, R.G. and C. Anderson: 1982, 'Related Donors and Recipients: Five to Nine Years Post-Transplant', Transplantation Proceedings 14, 9–12.

    Google Scholar 

  • Simmons, R.G., C. Anderson and L. Kamstra: 1984, 'Comparison of Quality of Life of Patients on Continuous Ambulatory Peritoneal Dialysis, Hemodialysis, and after Transplantation', American Journal of Kidney Diseases 4, 253–255.

    PubMed  CAS  Google Scholar 

  • Simmons, R.G. and S.D. Klein: 1977, Gift of Life: the Social and Psychological Impact of Organ Transplantation.New York, NY: Wiley.

    Google Scholar 

  • Smit, H., M. Molzahn, G. Kirste, R. Grupp and A. Koehler: 2000, Organspende und Transplantation in Deutschland 1999. Neu-Isenburg: Deutsche Stiftung Organtransplantation.

    Google Scholar 

  • Smit, H., R. Sasse, M. Molzahn and B. Schulin: 1999, Organspende und Transplantation in Deutschland 1998.Neu-Isenburg: Deutsche Stiftung Organtransplantation.

    Google Scholar 

  • Smith A.: 1995, 'An Analysis of Altruism: A Concept of Caring', Journal of Advanced Nursing 22, 785–790.

    PubMed  CAS  Article  Google Scholar 

  • Spital, A.: 1996, 'Do U.S. Transplant Centers Encourage Emotionally Related Kidney Donation?', Transplantation 61, 374–377.

    PubMed  CAS  Article  Google Scholar 

  • Switzer, G.E.,M.A. Dew, V.A. Butterworth, R.G. Simmons and M. Schimmel: 1997, 'Understanding Donors' Motivations: A Study of Unrelated Bone Marrow Donors', Social Science and Medicine 45(1), 137–147.

    PubMed  CAS  Article  Google Scholar 

  • Teraski, P.I.,M.J. Cecka, D.W.Gjertson and S. Takemoto: 1995, 'High Survival Rates of Kidney Transplants from Spousal and Living Unrelated Donors', New England Journal of Medicine 333, 333–336.

    Article  Google Scholar 

  • Trotter, J.F., M. Talamantes, M. McClure, M. Wachs, T. Bak, T. Trouillot, M. Kugelmas, G.T. Everson and I. Kam: 2001, 'Right Hepatic Lobe Donation for Living Donor Liver Transplantation: Impact on Donor Quality of Life', Liver Transplantation 7, 485–493.

    PubMed  CAS  Article  Google Scholar 

  • United Network for Organ Sharing: 1999a, UNOS Transplant Patient Data Source. National Results for Kidney. Available at: http://www.patients.unos.org/tpd/.

  • United Network for Organ Sharing: 1999b, Number of Living Donors: January 1, 1988-June 30, 1999.Richmond, VA: UNOS OPTN/Scientific Registry.

    Google Scholar 

  • Vaccarino, V., L. Parsons, N.R. Every, H.V. Barron and H.M. Krumholz: 1999, 'Sex-Based Differences in Early Mortality after Myocardial Infarction', New England Journal of Medicine 341, 217–225.

    PubMed  CAS  Article  Google Scholar 

  • Westlie, L., P. Fauchald, T. Talseth, A. Jakobsen and A. Flatmark: 1993, 'Quality of life in Norwegian kidney donors', Nephrology, Dialysis, Tranplantation 8, 1146–1150.

    CAS  Google Scholar 

  • Zimmerman, D., S. Donnelly, J. Miller, D. Stewart and S.E. Albert: 2000, 'Gender Disparity in Living Renal Transplant Donation', American Journal of Kidney Diseases 36, 534–540.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nikola Biller-Andorno.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Biller-Andorno, N. Gender imbalance in living organ donation. Med Health Care Philos 5, 199–203 (2002). https://doi.org/10.1023/A:1016053024671

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1016053024671

  • ethical issues
  • gender
  • living organ donation
  • transplantation