Addressing sex-based disparities in solid organ transplantation in the United States - a conference report

Deirdre Sawinski¹, Jennifer C Lai², Sean Pinney³, Alice L Gray⁴, Annette M Jackson⁵, Darren Stewart⁶, Deborah Jo Levine⁷, Jayme E Locke⁸, James J Pomposelli⁹, Matthew G Hartwig¹⁰, Shelley A Hall¹¹, Darshana M Dadhania¹², Rebecca Cogswell¹³, Richard V Perez¹⁴, Jesse D Schold¹⁵, Nicole A Turgeon¹⁶, Jon Kobashigawa¹⁷, Jasleen Kukreja¹⁸, John C Magee¹⁹, John Friedewald²⁰, John S Gill²¹, Gabriel Loor²², Julie K Heimbach²³, Elizabeth C Verna²⁴, Mary Norine Walsh²⁵, Norah Terrault²⁶, Guiliano Testa²⁷, Joshua M Diamond²⁸, Peter P Reese²⁹, Kimberly Brown³⁰, Susan Orloff³¹, Maryjane A Farr³², Kim M Olthoff³³, Mark Siegler³⁴, Nancy Ascher³⁵, Sandy Feng³⁵, Bruce Kaplan⁹, Elizabeth Pomfret⁹

Affiliations

¹ Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA. Electronic address: dls7001@med.cornell.edu.
² Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA.
³ University of Chicago Medicine, Chicago, Illinois, USA.
⁴ University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
⁵ Department of Surgery, Duke University, Department of Surgery, Durham, Carolina, USA.
⁶ United Network for Organ Sharing, Richmond, Virginia, USA.
⁷ University of Texas Health, San Antonio, Texas, USA.
⁸ University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama, USA.
⁹ Department of Surgery University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA.
¹⁰ Duke University School of Medicine, Durham, Carolina, USA.
¹¹ Baylor University Medical Center, Dallas, Texas, USA.
¹² Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA.
¹³ University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
¹⁴ Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA.
¹⁵ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁶ UT Dell Medical School, Austin, Texas, USA.
¹⁷ Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
¹⁸ Department of Surgery, University of California, San Francisco, California, USA.
¹⁹ Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
²⁰ Northwestern University Feinberg School of Medicine, Chicago, Illinois USA.
²¹ Division of Nephrology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada.
²² Baylor College of Medicine Lung Institute, Houston, Texas, USA.
²³ Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
²⁴ Center for Liver Disease and Transplantation, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA.
²⁵ Ascension St Vincent Heart Center, Indianapolis, Indianapolis, Indiana, USA.
²⁶ Keck Medicine of University of Southern California, Los Angeles, California, USA.
²⁷ Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA.
²⁸ Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁹ Division of Renal, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³⁰ Henry Ford Hospital, Detroit, Michigan, USA.
³¹ Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Portland, Oregon, USA.
³² Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
³³ Department of Surgery, Penn Transplant Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³⁴ University of Chicago Medicine, Chicago, Illinois, USA; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA.
³⁵ Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA.

PMID: 36906294
DOI: 10.1016/j.ajt.2022.11.008

Free article

Addressing sex-based disparities in solid organ transplantation in the United States - a conference report

Deirdre Sawinski et al. Am J Transplant. 2023 Mar.

Free article

. 2023 Mar;23(3):316-325.

doi: 10.1016/j.ajt.2022.11.008. Epub 2023 Jan 12.

Authors

Affiliations

¹ Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA. Electronic address: dls7001@med.cornell.edu.
² Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA.
³ University of Chicago Medicine, Chicago, Illinois, USA.
⁴ University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.
⁵ Department of Surgery, Duke University, Department of Surgery, Durham, Carolina, USA.
⁶ United Network for Organ Sharing, Richmond, Virginia, USA.
⁷ University of Texas Health, San Antonio, Texas, USA.
⁸ University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama, USA.
⁹ Department of Surgery University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA.
¹⁰ Duke University School of Medicine, Durham, Carolina, USA.
¹¹ Baylor University Medical Center, Dallas, Texas, USA.
¹² Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA.
¹³ University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
¹⁴ Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA.
¹⁵ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁶ UT Dell Medical School, Austin, Texas, USA.
¹⁷ Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
¹⁸ Department of Surgery, University of California, San Francisco, California, USA.
¹⁹ Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
²⁰ Northwestern University Feinberg School of Medicine, Chicago, Illinois USA.
²¹ Division of Nephrology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada.
²² Baylor College of Medicine Lung Institute, Houston, Texas, USA.
²³ Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
²⁴ Center for Liver Disease and Transplantation, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA.
²⁵ Ascension St Vincent Heart Center, Indianapolis, Indianapolis, Indiana, USA.
²⁶ Keck Medicine of University of Southern California, Los Angeles, California, USA.
²⁷ Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA.
²⁸ Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁹ Division of Renal, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³⁰ Henry Ford Hospital, Detroit, Michigan, USA.
³¹ Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Portland, Oregon, USA.
³² Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
³³ Department of Surgery, Penn Transplant Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³⁴ University of Chicago Medicine, Chicago, Illinois, USA; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA.
³⁵ Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA.

PMID: 36906294
DOI: 10.1016/j.ajt.2022.11.008

Abstract

Solid organ transplantation provides the best treatment for end-stage organ failure, but significant sex-based disparities in transplant access exist. On June 25, 2021, a virtual multidisciplinary conference was convened to address sex-based disparities in transplantation. Common themes contributing to sex-based disparities were noted across kidney, liver, heart, and lung transplantation, specifically the existence of barriers to referral and wait listing for women, the pitfalls of using serum creatinine, the issue of donor/recipient size mismatch, approaches to frailty and a higher prevalence of allosensitization among women. In addition, actionable solutions to improve access to transplantation were identified, including alterations to the current allocation system, surgical interventions on donor organs, and the incorporation of objective frailty metrics into the evaluation process. Key knowledge gaps and high-priority areas for future investigation were also discussed.

Keywords: disparities; ethics and public policy; heart transplant; kidney transplant; liver transplant; lung transplant; organ allocation; organ procurement and allocation; sex disparities; solid organ transplantation.

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Addressing sex-based disparities in solid organ transplantation in the United States - a conference report

Affiliations

Addressing sex-based disparities in solid organ transplantation in the United States - a conference report

Authors

Affiliations

Abstract

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LinkOut - more resources

Full Text Sources

Medical