Gender in Organ Transplantation: Unpacking Inequality

Abstract

Studies in the medicine suggest that women are at a disadvantage compared to men at critical stages of organ transplantation. These stages include diagnosis of organ failure, referral to specialists, placement on waiting lists, access to organs and post-transplant follow-up. However, women are disproportionately represented among living organ donors. This study examines these gender-based inequalities through the lens of Risman’s theory of “gender as a social structure.” Through literature review, the research evaluates gender inequalities in organ transplantation processes at individual, interactional and institutional levels. Drawing on empirical studies conducted in various international contexts, it discusses in detail the disadvantages women encounter at different stages of the transplantation process.

Keywords

• Organ transplantation
• gender inequality
• organ donation
• sex disparity
• health

Organ Naklinde Toplumsal Cinsiyetin Rolü: Eşitsizliği Anlamak

Abstract

Tıp literatüründe yapılan çalışmalar, organ nakli sürecinde kadınların, organ yetmezliği tanısı alma, uzman hekime yönlendirilme, bekleme listesine dahil edilme, organ temini ve nakil sonrası izlem gibi hayati aşamalarda erkeklere kıyasla dezavantajlı konumda olduğunu göstermektedir. Öte yandan kadınların canlı organ bağışçısı olarak orantısız bir biçimde temsil edildiği de dikkat çekici bir bulgudur. Bu çalışma, söz konusu eşitsizlikleri, Risman’ın “bir yapı olarak toplumsal cinsiyet” teorisi çerçevesinde incelemektedir. Literatür tarama yöntemiyle yürütülen bu araştırma, organ nakli süreçlerindeki toplumsal cinsiyet temelli eşitsizlikleri bireysel, etkileşimsel ve kurumsal düzeylerde ele alarak değerlendirmektedir. Uluslararası alanda yapılmış ampirik araştırmalar doğrultusunda, kadınların organ nakli süreçlerinin çeşitli aşamalarında karşılaştığı dezavantajlar tartışılmaktadır

Keywords

• Organ nakli
• cinsiyet eşitsizliği
• toplumsal cinsiyet
• sağlık

References

1. Artan, Ayşe Serra vd. “Pregnancy in Living Kidney Donors: An Evidence-Based Review.” Curr Transpl Rep 10 (2023): 110–116.
2. Aydın, Mehmet Ali vd. “Türkiye Organ ve Doku Bilgi Sistemi Ulusal Verilerine Göre Canlı Vericili Böbrek Nakli Takip Sonuçları.” Türk Anesteziyoloji ve Reanimasyon Derneği Akademisi, 48.Ulusal Kongresi 24-28 Ekim 2014.
3. Azoulay, Daniel vd. “Short- and Long-Term Donor Morbidity in Right Lobe Living Donor Liver Transplantation: 91 Consecutive Cases in a European Center.” American Journal of Transplantation 11, no.1 (2011): 101-10.
4. Badinter, Elisabeth. The Myth of Motherhood: A Historical View of the Maternal Instinct (Londra: Souvenir Press, 1981).
5. Bayraktar, Sevi. Makbul Anneler Müstakbel Vatandaşlar (Ankara: Ayizi, 2011).
6. Benjamens, Stan, vd. “Gender Disparities in Authorships and Citations in Transplantation Research.” Transplantation Direct 6 , no.11 (2020): p e614.
7. Beauvoir, De Simone. İkinci Cinsiyet (İstanbul: Koç Üniversitesi Yayınları, 2019).
8. Bikbov, Boris vd. “Global, Regional, and National Burden of Chronic Kidney Disease, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017”. The Lancet 395, no. 10225 (2020): 709–733.

9. Bourdieu, Pierre. Masculine Domination (Stanford: Stanford University Press, 2001).
10. Breton, David Le. Ten ve İz: İnsanın Kendini Yaralaması Üzerine (İstanbul: Sel, 2021).
11. Brige, Pauline vd. “Morbidity and Mortality of Hepatic Right Lobe Living Donors: Systematic Eeview and Perspectives.” Journal of Gastrointestinal and Liver Diseases : JGLD 27, no. 2 (2018): 169-178.
12. Brooks, Barbara vd. “Influence of Donor and Recipient Gender on the Outcome of Liver Transplantation.” Transplantation 62 (1996): 1784–1787.
13. Carrero, Juan Jesus, vd. “Sex and Gender Disparities in the Epidemiology and Outcomes of Chronic Kidney Disease.” Nat Rev Nephrol 14 no.3 (2018): 151-164.
14. Cullaro, Giuseppe vd. “Sex-based Disparities in Delisting for Being "Too Sick" for Liver Transplantation.” Am J Transplant 18, no. 5 (2018) :1214-1219.
15. Chen, Liping, vd. “Outcomes in Kidney Transplantation with Mycophenolate Mofetil‐Based Maintenance Immunosuppression in China: A Large‐Sample Retrospective Analysis of a National Database.” Transplant International 33, no. 7 (2020): 718–728.
16. Christie, Emily vd. “Policy and Statistical Barriers Impeding Organ Transplant for Transgender, Gender Diverse and Nonbinary Patients.” Curr Transpl Rep 11 (2024): 266–275.
17. Chodorow, Nancy. The Reproduction of Mothering: Psychoanalysis and the Sociology of Gender (Berkeley, CA: University of California Press, 1978).
18. Çakır Akın vd. “Preeklampsi ve Eklampsi (Gebelik Toksemisi): Patogenez, Tanı ve Tedavi.” Güncel Retina 7 , no.3 (2023): 234-239.
19. Çifcibaşı Örmeci, Aslı. “Karaciğer Nakil Sırasında Bekleyen Hastalarda Kadın Cinsiyet Dezavantaj mı?” Gastroenterohepatolojide Cinsiyet Farklılığının Önemi, ed. Ömer Şentürk (Ankara: Türkiye Klinikleri, 2021), 37–40.
20. Clerc Liaudat, Christelle vd. “Sex/gender Bias in the Management of Chest Pain in Ambulatory Care.” Women's Health 14 (2018): 1745506518805641.
21. Cozzi, Emanuele vd. “An Analysis by the European Committee on Organ Transplantation of the Council of Europe Outlining the International Landscape of Donors and Recipients Sex in Solid Organ Transplantation.” Transplant International: Official Journal of the European Society for Organ Transplantation 35 (2022): 10322.
22. Crowley-Matoka, Megan. Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico (Durham, NC: Duke University Press, 2016).
23. Delphy, Christine. The Main Enemy: A Materialist Analysis of Women's Oppression (Londra: Women's Research and Resources Centre, 1977).
24. Demirhan, Sezen. Being a Living Organ Donor: A Study on Women's Experiences. Doktora tezi (Akdeniz Üniversitesi, 2024).
25. De Carlis, Riccardo vd. “The Long-term Follow-up of the Living Liver Donors.” Updates in Surgery (2024): 10.1007/s13304-024-01894-4.
26. Doğan, Runida vd. “Bakım Verici Rolü Olan Karaciğer Nakli Donörlerinde Bakım Yükü ve Depresyon Arasındaki İlişki.” ADYÜ Sağlık Bilimleri Derg 7, no.3 (2021): 277-285.
27. Ehrenreich, Barbara ve Deirdre English. Witches, Midwives, and Nurses. A History of Women Healers (New York: The Feminist Press at CUNY, 1973).
28. Fallahzadeh, Mohammad Kazem. “Comparison of Health Status and Quality of Life of Related Versus Paid Unrelated Living Kidney Donors.” American Journal of Transplantation 13, no.12 (2013): 3210–3214.
29. Fausto-Sterling, Anne. “The Five Sexes: Why Male and Female Are Not Enough.” The Sciences 33 (2007): 20-24
30. Federici, Silvia. Caliban and the Witch: Women, the Body and Primitive Accumulation. (New York: Autonomedia, 2004).
31. Foucault, Michel. The Birth Of Biopolitics. (New York: Palgrave Macmillan, 2008).
32. Gameiro, Cátia Morgado vd. “Menopause and Aging: Changes in the Immune System-A Review.” Maturitas vol. 67,4 (2010): 316-20.
33. Gezici, Armağan ve Özge Özay. “An Intersectional Analysis of COVID-19 Unemployment.” Journal of Economics, Race, and Policy 3 (2020): 213–224.
34. Gilligan, Carol. Kadının Farklı Sesi: Psikolojik Kuram ve Kadının Gelişimi (İstanbul: Pinhan Yayıncılık, 2017).
35. Godara, Suraj ve Jitesh Jeswani. “Women Donate, Men Receive: Gender Disparity Among Renal Donors.” Saudi J Kidney Dis Transpl 30 no.6 (2019): 1439-1441.
36. Gordon, Elisa J. vd. “Implementing Culturally Competent Transplant Care and Implications for Reducing Health Disparities: A Prospective Qualitative Study.” Health Expectations 23, no.6 (2020): 1450-1465.
37. Hamilton, David. A History of Organ Transplantation: Ancient Legends to Modern Practice (Pittsburgh: University of Pittsburgh Press, 2012).
38. Harding, Jessica L vd. “Sex/Gender Disparities in Preemptive Referrals for Kidney Transplantation.” Kidney International Reports 9, no.7 (2024): 2134-2145.
39. Harding, Sandra. “Introduction: Standpoint Theory as a Site of Political, Philosophic, and Scientific Debate.” The Feminist Standpoint Theory Reader: Intellectual and Political Controversies ed. Sandra G Harding, (New York: Routledge, 2001), 1-15.
40. Harper, Ann vd.“The UNOS OPTN Waiting List and Donor Registry.” Clinical Transplantats (1998): 73–90. Hödlmoser, Sebastian vd. “Sex Differences in Kidney Transplantation: Austria and the United States, 1978–2018” Frontiers in Medicine 8 (2021): 800933.
41. John S. Gill vd. “Differential Association of Body Mass Index with Access to Kidney Transplantation in Men and Women.” Clinical Journal of the American Society of Nephrology 5, no. 9 (2014): 951-959
42. Juliato, Cássia Raquel Teatin vd. “Women After Solid Organ Transplantation: An Overview of Gynecological Health.” BJT 26, no. 01 (2023): e3923
43. Katz-Greenberg, Goni, ve Silvi, Shah. “Sex and Gender Differences in Kidney Transplantation.” Seminars in Nephrology 42, no. 2 (2022): 219–229.
44. Kurnikowski, Amelie vd. “Country-Specific Sex Disparities in Living Kidney Donation.” Nephrol Dial Transplant 37, no. 3 (2022): 595-598.
45. Lai, Jennifer vd. “Height Contributes to the Gender Difference in Wait-List Mortality Under the MELD-Based Liver Allocation System.” American Journal of Transplantation 10, no.12 (2010): 2658–2664.
46. Lai, S. Feng vd. “Gender Differences in Liver Donor Quality Are Predictive of Graft Loss.” American Journal of Transplantation 11, no. 2 (2011): 296-302.
47. Levinsky, Norman G. “Organ Donation by Unrelated Donors.” New England Journal of Medicine 343 (2000): 430–432.
48. Leeies, Murdoch, vd. “Inequities in Organ and Tissue Donation and Transplantation for Sexual Orientation and Gender Identity Diverse People: A Scoping Review.” American Journal of Transplantation, volume 24, no. 1 (2024): 11 – 19.
49. Leeies, Murdoch vd. “Sexual Orientation and Gender Identity in Organ and Tissue Donation and Transplantation.” Nature Reviews Nephrology 6 (2023): 357-358.
50. Listabarth, Stephan, vd. “Sex Disparities in Outcome of Patients with Alcohol-Related Liver Cirrhosis within the Eurotransplant Network—A Competing Risk Analysis.” Journal of Clinical Medicine 11, no. 13 (2022): 3646.
51. Lorber, Judith. Paradoxes of Gender (Binghamton, New York: Yale University Press, 1994).
52. Maserejian N. Nancy vd. “Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment.” Journal of Women's Health 18 no.10 (2009): 1661–1667.
53. Meidert, Ursula vd. “Unconscious Bias among Health Professionals: A Scoping Review.” International Journal of Environmental Research and Public Health 20, no.16 (2023): 6569.
54. Melk, Anette vd. “Equally Interchangeable? How Sex and Gender Affect Transplantation.” Transplantation. 103, no.6 (2019): 1094-1110.
55. Mıhçıokur, Sare vd. “Gender Disparity and the Relationship Between Living Donors and Recipients in Kidney Transplants in an Organ Transplant Center in Turkey.” Experimental and Clinical Transplantation 17, Suppl 1 (2019): 246-249.
56. Mies, Maria. Patriarchy and Accumulation on a World Scale: Women in the International Division of Labour. (London: Zed Books, 1986).
57. Mies, Maria vd. Son Sömürge: Kadınlar (İstanbul: İletişim Yayınları, 2008).
58. Mindikoglu, Ayşe vd. “Gender Disparity in Liver Transplant Waiting-List Mortality: The Importance of Kidney Function” Liver Transpl. 16(10) (2010): 1147-1157. [yayımlanmıi düzeltme Liver Transpl 1 no.9 (2011):1119].
59. Mishra, Nishtha ve Muthusamy Sivakami. “…I Felt Obliged to Him and Donated My Organ: Gendered Experiences of Women Living Organ Donors in India.” Handbook on Sex, Gender and Health Perspectives from South Asi eds/ Ravindran, T.S., Sivakami, M., Bhushan, A., Rashid, S.F., Khan, K.S. (Singapore: Springer, 2024).
60. Nephew, Lauren vd. “Exception Points and Body Size Contribute to Gender Disparity in Liver Transplantation.” Clinical Gastroenterology and Hepatology 15, no.8 (2017): 1286–1293.e2.
61. Nicholson, Michael L. ve J. Andrew Bradley. “Renal Transplantation from Living Donors.” British Medical Journal 318 (1999): 409–410.
62. Öncel, Mehmet Yekta, vd. “Anansefalik Yeni doğanların Organ Naklindeki Yeri: Bir Olgu Nedeniyle.” Türk Pediatri Arşivi 48 no. 2 (2013): 165-168.
63. Papagaroufali, Eleni. “Playing with One’s Own Death While Being Alive: The Case of Registered Body–Organ Donors in Greece.” Anthropology and Humanism 31 (2006): 111-123.
64. Papagaroufali, Eleni. “Donations of Human Organs or Bodies After Death: A Cultural Phenomenology of ‘Flesh’ in the Greek Context.” Ethos 27 (1999): 283-314.
65. Parra, Natalia Salinas vd. “Prevalence of Post-Liver Transplant Complications and NASH-Related Cirrhosis in Postmenopausal Women.” Annals of Hepatology 29, no. 1 (2024): 101-157
66. Peracha, Javeria vd. “Gender Disparity in Living-Donor Kidney Transplant Among Minority Ethnic Groups.” Experimental and Clinical Transplantation 2 (2016): 139–145.
67. Priebe, Stefan vd. “Good Practice in Health Care for Migrants: Views and Experiences of Care Professionals in 16 European Countries.” BMC Public Health 11 (2011): 187-199.
68. Pruthi, Rishi vd. “Inequity in Access to Transplantation in the United Kingdom.” Clinical journal of the American Society of Nephrology: CJASN 15, no.6 (2020): 830-842.
69. Rich, Adrienne. Kadından Doğma: Deneyim ve Kurum Olarak Annelik (İstanbul: Otonom Yayıncılık, 2024).
70. Risman, Barbara. J. “Can Men “Mother?” Life as a Single Father.” Family Relations, 35, no. 1 (1986): 95–102,
71. Risman, Barbara J. “Intimate Relationships from a Microstructural Perspective: Men Who Mother.” Gender and Society 1, no. 1 (1987): 6–32.
72. Risman, Barbara J. “Gender as a Social Structure: Theory Wrestling with Activism.” Gender and Society 18, no. 4 (2004): 429–50.
73. Rodríguez-Perálvarez, Manuel Luis, vd. “Development and Validation of the Gender-Equity Model for Liver Allocation (GEMA) to Prioritise Candidates for Liver Transplantation: A Cohort Study.” The Lancet Gastroenterology & Hepatology 8, no.3 (2023): 242-252.
74. Rodríguez-Castro vd. “Female Gender in the Setting of Liver Transplantation.” World J Transplant 4, no.4 (2014): 229-242.
75. Rota-Musoll, Laura, vd. “An intersectional Gender Analysis in Kidney Transplantation: Women Who Donate a Kidney.” BMC nephrology 22, no.1 (2021): 22-59.
76. Sarkar Monika vd. “Outcomes in Liver Transplantation: Does Sex Matter?” Journal of Hepatology 62, no.4 (2015): 946–955.
77. Schicktanz, Silke, vd. “Gender Issues in Living Organ Donation: Medical, Social and Ethical Aspects.” Sex and Gender in Biomedicine: Theories, Methodologies, Results, ed. Ineke Klinge and Claudia Wiesemann (Göttingen: Universitätsverlag Göttingen, 2010), 33–55.
78. Seiler, Annina vd. “Post-Transplant Outcome—Clusters of Psychological Distress and Health-Related Quality of Life in Lung Transplant Recipients.” Swiss Medical Weekly 145 (2015): w14236.
79. Sheikh, Saulat vd. “Gender Disparities in Transplantation.” Curr Opin Organ Transplant. 26 no.5 (2021): 513-520.
80. Sherwin, Susan. No Longer Patient Feminist Ethics and Health Care (Philadelphia: Temple University Press, 1992).
81. Sonnenberg, Elizabeth M vd. “Pregnancy Outcomes After Living Liver Donation: A Multi-Institutional Study.” Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 27, no.9 (2021): 1262-1272.
82. Steinman, Judith L. “Gender Disparity in Organ Donation.” Gender Medicine 3 no.4 (2006): 246-52.
83. Tejedor, Marta vd. “Women Are Also Disadvantaged in Accessing Transplant Outside the United States: Analysis of the Spanish Liver Transplantation Registry.” Transplant International: Official Journal of the European Society for Organ Transplantation 37 (2024): 12732.
84. Thiel, Gert vd. “Gender Imbalance in Living Kidney Donation in Switzerland.” Transplantation Proceedings vol. 37, no.2 (2005): 592-4.
85. Thirumavalavan, Nannan vd. “Does Solid Organ Transplantation Affect Male Reproduction?” Eur Urol Focus 4, no.3 (2018): 307-310.
86. Vereerstraeten, P vd. “Male Recipients Of Kidneys From Female Donors are at Increased Risk of Graft Loss From Both Rejection and Technical Failure.” Clin Transplant 13, no.2 (1999): 181-186.
87. World Health Organization. “Delivered by Women, Led by Men: A gender and Equity Analysis of the Global Health and Social Workforce.” Human Resources for Health Observer Series 24 (Geneva, 2019).
88. Wood, L. Nicholas vd. “Correcting the Sex Disparity in MELD-Na.” American Journal of Transplantation: Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons 21, no.10 (2021): 3296-3304.
89. West, Candace ve Don. H. Zimmerman. “Doing Gender” Gender & Society 1, no.2 (1987): 125-151.
90. Yea, Sallie. “Masculinity under the knife: Filipino Men, Trafficking and the Black Organ Market in Manila, the Philippines.” Gender, Place & Culture 22(1) (2013): 123–142.
91. Young, Iris. Marion. On Female Body Experience: “Throwing Like a Girl” and Other Essays (New York: Oxford University Press, 2005).
92. Young, Iris Marion. Adalet ve Farklılık Politikası (Ankara: Ayrıntı, 2023).
93. Zeiler, Kristin vd. “Moral Tales of Parental Living Kidney Donation: A Parenthood Moral Imperative and Its Relevance For Decision Making.” Med Health Care and Philos 13 (2010): 225–236
94. Zimmerman, Deborah vd. “Gender Disparity in Living Renal Transplant Donation.” American Journal of Kidney Diseases 36, no.3 (2000): 534–540.