Global Observatory on Donation and Transplantation on Gender Disparity in Organ Transplantation in India From 2019 to 2023

Le résumé fourni par la source

We read with interest the recent survey of Indian nephrologists on gender disparities in kidney transplantation.1 The official real-world national data from the Global Observatory on Donation and Transplantation and National Organ and Tissue Transplant Organization (NOTTO), Directorate General of Health Services, Ministry of Health and Family Welfare (MoHFW), Government of India, is freely available and could reinforce the findings of the study. During the past 5 y (2019–2023), 30% of living donor kidney transplant recipients were women, compared with 70% men, whereas 66.2% of living kidney donors were women, compared with 33.8% men. The percentage of female kidney transplant recipients (from both living and deceased donors) has increased over time (n = 2734 [28%] in 2019 to n = 4939 [36.8%] in 2023). Specifically, more women have received living donor kidney transplantation (n = 2347 [27.2%] in 2019, increasing to n = 4383 [37.2%] in 2023). Likewise, more women have received liver transplants (from both living and deceased donors). Overall, the percentage has increased from a quarter of all recipients in 2019 to almost one-third in 2023. The percentage of female heart transplant recipients remains low, with women representing a quarter of all heart transplant recipients. The percentage of female lung transplant recipients has slightly increased, whereas the percentage of female pancreas transplant recipients has remained relatively stable over the time period, with female recipients receiving half of all lung transplants and a quarter of all pancreas transplants. In contrast, women continue to contribute the majority of living kidney donors with an increase in absolute numbers from 2019 to 2023, albeit a consistent relative contribution (n = 5633 and n = 7733, respectively; contributing approximately 65% of living donors) Similarly, more than half of all living liver donors were women throughout the past 5 y. The percentage of female deceased donors (all organs) continues to remain below a quarter of all deceased donors.2–4 In contrast to the national data, 89.7% of nephrologists in the survey reported that <25% of kidney transplant recipients in their practice were women, whereas 55% reported that >75% of kidney donors in their practice were women.1 We have identified several limitations of the survey: (1) a total of 635 kidney transplant centers are reported to NOTTO, including 551 (87.3%) in private hospitals and 81 (12.7%) in public sector hospitals. As per the Transplantation of Human Organs and Tissues Act, 2014, each center must have 2 nephrologists/transplant physicians to obtain permission for kidney transplantation. With an estimated ≥1270 nephrologists nationwide, the survey’s participation rate (267/800 nephrologists) appears low. (2) The deceased donor kidney transplant program in India has contributed to 12.2% (n = 1635) of the total 13 426 kidney transplants in 2023. It is more active in South and West India, particularly in Tamil Nadu, Telangana, Maharashtra, Karnataka, and Gujarat, than in North India. It remains underdeveloped in Northeast India, with recent anecdotal reports from Manipur and Assam. According to Figure 1 of the reported survey, only 1.9% of the women received a kidney from a deceased donor whereas no men did. This suggests the survey was answered by nephrologists practicing in states with limited or no deceased donations, rather than from across the nation. This indicates limited representation from diverse transplant centers, particularly from regions with an active deceased donation transplant program. (3) The survey offers perspectives from practicing clinicians in diverse settings. The official statistics and clinical surveys can each offer valuable but different insights. To enhance the validity and applicability of the survey, adding more details would have been beneficial, such as (1) duration and years of data collection, (2) number of transplant centers, (3) participant demographics (age, gender, job position, location), and (4) differentiation between public and private hospitals. Furthermore, collecting data from multiple nephrologists at the same center may not have added value. Providing these details would have facilitated a more comprehensive understanding of the strengths and limitations of the survey. In 2020, the State Organ and Tissue Transplant Organization, Gujarat, implemented a point-based system for the allocation of deceased donor kidneys. This included awarding 2 extra points to female candidates, which led to an increase in female recipients from 27.57% in 2019 to 50.76% in 2024.5 All patients with end-stage kidney disease receive free dialysis under the Gujarat Dialysis Program, run by the Government of Gujarat. The program has provided 2 794 774 free dialysis sessions to approximately 5000 patients on maintenance dialysis through 280 satellite units. The authors of the article have called for national and state-sponsored schemes that provide financial and other incentives to address this issue. Several such policies are already in place and need to be highlighted. The Pradhan Mantri National Dialysis Programme was launched on April 7, 2016, under the National Health Mission (MoHFW) to provide free dialysis services to the poor. As of December 31, 2024, the program has 10 850 hemodialysis machines at 1575 centers and has provided 31.36 million hemodialysis sessions for 2.649 million patients across 36 states.6 Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, launched by the MoHFW on September, 23, 2018, is the world’s largest publicly funded health assurance scheme. It provides health coverage of Rs. 0.5 million per family per year for secondary and tertiary care hospitalization, covering 550 million individuals, corresponding to 1.234 million families. Pradhan Mantri Jan Arogya Yojana provides free kidney transplants, the majority of which are performed in public sector kidney transplant hospitals across India.3,7 Launched in 1997, Rashtriya Arogya Nidhi provides financial support of up to Rs. 1.5 million for organ transplants, including heart, lung, liver, and kidney, for patients below the poverty line.7 NOTTO provides 10 000 INR (USD 117) per month for immunosuppressants to below the poverty line recipients transplanted in government hospitals. In conclusion, the government-reported data and clinician-reported experiences provide complementary perspectives on the issue. Furthermore, we highlight government initiatives and existing policies aimed at addressing gender disparities in transplantation and overcoming financial barriers to access renal replacement therapy in India, ultimately benefiting many underprivileged patients.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.