Unequal access to living donor kidney transplant

UCLA Former Users Transplant News

When someone’s kidneys fail, a transplant may be their best treatment option. Unfortunately, there are not enough kidneys for the almost 100,000 people who are waiting for a kidney in the United States today.

The mission of the United Network of Organ Sharing is to reduce the organ donor shortage and ensure equal access to transplants for all Americans. Living donor kidney transplant (LDKT), where a friend or a family member donates a kidney to someone in need, can help more people receive transplants. Every year over 5000 friends or family members donate a kidney while alive to help someone who needs one. LDKT is one important way to reduce the organ donor shortage and ensure that people of every race, ethnicity, financial situation and gender get kidney transplants.

However, several articles have found that challenges to equal access to LDKT remain. An article recently published in the Journal of the American Medical Association found that Black and Hispanic patients are less likely to receive kidneys from living donors than White patients.1  Tanjala Purnell, PhD, MPH, of the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health, the lead author on the article, said it is “disappointing and surprising to find that the disparities have actually gotten much worse over the last two decades.” The researchers suggested that inconsistent education, lack of health insurance coverage, and a lack of living donors in these communities (possibly due to an increase in disqualifying diseases such as obesity, diabetes and hypertension) might play a part in why this disparity exists.

Another article, published in the Journal of the American Society of Nephrology, by Dr. Jagbir Gill of the University of British Columbia and colleagues, says there has been a steady decline in kidney donations in the U.S. by men and by people in low-income households. Overall, women donate more kidneys than men in the United States, but from 2005 to 2015 the difference grew wider as donations from women remained the same, but donations from men declined. The authors felt that, while surgery costs are covered for living donors, there are still other financial considerations that might play a part, including paying for childcare, and the need to take time off of work, which means not only loss of income but also possible loss of important health insurance benefits. While lower income was associated with lower donation rates in both men and women, these financial concerns seemed to play a bigger role for men than women.

“It will be important to develop policy and educational interventions to ensure that generous donors have the financial support and knowledge they need to recover from donation and not be financially harmed,” says Amy Waterman, PhD, Associate Professor in Nephrology and Deputy Director of the Terasaki Research Institute. “With these protections in place, it is possible that more individuals could step forward to donate kidneys to people they care about without harm to themselves.”


  1. Purnell TS, Luo X, Cooper LA,  Massie AB, Kucirka LM, Henderson ML, Gordon EJ, Crews DC, Boulware LE, Segev DL.  Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014. JAMA, 2018. 319(1): p. 49-61.
  2.  Gill J, Joffres Y, Rose C, Lesage J, Landsberg D, Kadatz M, Gill J. The Change in Living Kidney Donation in Women and Men in the United States (2005-2015): A Population-Based Analysis. J Am Soc Nephrol. 2018 Mar 8. pii: ASN.2017111160. doi: 10.1681/ASN.2017111160. [Epub ahead of print]