403.5: The breadwinner and the homemaker: A systematic literature review to explore gender differences in the motivation of donors and candidates to pursue living kidney donation.
Bibliographic record
Abstract
Background: The over-representation of females as living kidney donors (LKDs) in most countries is well documented. Medical reasons and sex-related differences - the biological and physiological features of males and females - are unlikely to be the sole drivers of this disparity. It is widely believed that these trends represent a gender disparity. Methods: We conducted a systematic review to synthesize existing literature that had examined gender differences in motivation to pursue living kidney donation. Six electronic and two grey literature databases were searched systematically. Of the 3,188 records screened 16 empirical studies and case studies from 9 higher and 4 lower-middle income countries were included in the final analysis. Data were synthesized thematically, using the four-level social-ecological model lens.Results: Studies were limited to two genders, tended to focus on the perspectives of women only and were predominantly descriptive. We have isolated the perspectives of 1,148 LKDs and candidates, 471 of whom were women, 290 were men, and 387 for whom gender/sex was not specified. Relationship and community factors constituted the main motivators, given that the majority of donations occurred within the family/friend network. These included overt or subtle family pressure, self-sacrifice for the well-being of the family, desire to improve recipients quality of life, beliefs in marital stability, and the differential economic status of women and men. Societal and cultural factors - gendered family roles; ethnic, religious and social norms and beliefs regarding marriageability and fertility; privileged social status of men and boys; and legislation and policy - were a cross-cutting theme influencing many elements of donation. At the individual level, LKDs exhibited strategic and deliberate decision-making. The relative importance of each factor varied based on geographical context, with more modest differences in motivation between men and women and stronger manifestation of individual factors in higher income countries. However, gender and sex were conflated in most studies, most lacked a strong methodologic approach and were at high risk of bias. Conclusion: Despite the recognition of sex and gender disparities in living kidney donation for over three decades, our review highlights a dearth of robust evidence explaining this phenomenon. Existing evidence highlights the need to understand the complex interplay of identified factors across different cultural and geo-political contexts using a rigorous methodologic approach. This can then inform targeted policy initiatives to advance gender equity and optimally promote donation among all genders. This work is supported by a 2023-24 Bridge Grant from the CIHR’s patient-oriented research priority announcement. Dr. Loban is supported by a Women in Transplantation Research Fellowship.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.038 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.016 | 0.016 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".