Gender Differences in Willingness to Be Evaluated for Living Kidney Donation

Introduction: Women comprise 55% to 65% of living kidney donors. Most studies focus on individuals who underwent donor nephrectomies, rather than potential living donors prior to engagement with the healthcare system. Therefore, the underlying reasons for gender discrepancy are unclear. Research question: Among relatives of patients with renal disease, do men and women differ in willingness to be evaluated for living kidney donation, regardless of prior donation behavior? Design: An online survey administered in 2019 to US adult members of the Qualtrics Survey Panel whose relatives had weak or failing kidneys. The survey was designed to examine perspectives of living kidney donation from realistic potential donors. Self-reported willingness was compared between men and women for statistically significant differences. Average marginal effects of male gender on willingness and interaction effects estimated with multivariable logistic regression, adjusted for respondent/patient demographics and relationship. Results: A total of 1647 responses showed 7.1% higher willingness among men (P = .016). Among those whose relatives (N = 808) were seeking transplants [subgroup], men had 13.1% higher willingness (P = .002). Interaction effect analysis showed men aged 70 to 79 years, with insurance, self-reported very good health, and self-reported medical contraindications, had significantly higher willingness than corresponding women. In the transplant subgroup, men aged 18 to 39 years and with full-time employment also had higher willingness. Conclusion: Men showed 7.1% higher willingness to be evaluated for living kidney donation. Rather than reflecting a fixed difference, the existence and degree of gender difference were context-dependent. Identifying strategic interventions to facilitate male donation in contexts where they reported high willingness could improve access to transplantation.