Rebirth and Transplantation: Women as Givers of Life

Human organ for transplantation design flat.Vector illustration

In an opinion piece for the New York Times in December, Sohini Chattopadhyay, a writer based in Kolkata, wrote about her father’s liver transplant. Sohini, who was his only child and had a compatible blood type, volunteered to be his donor after he became ill. Months later, fearing complications, she changed her mind, and her mother took her place.[1]

Sohini was free to make that choice. She was lucky. Many women in her position are not given a choice; they are coerced and pressured by their families to donate their organs to their relatives. Even in places where they do not experience such overt manipulation, women still account for the vast majority of living organ donations.[2]

Women make up 54% to 69% of all living donors according to global statistics.[3] The adjusted incidence of living kidney donation in the U.S. was 44% higher in women from 2005 to 2015. Donation rates among women remained stable over this ten-year period, while donation rates among men decreased.[4] In Switzerland, women make up 65% of living organ donors.[5] In India, women account for 75% to 82% of kidney donors. Indian men, on the other hand, make up a whopping 79% to 93% of kidney recipients.[6],[7]

Kidney and liver donations are among the most common transplant procedures. Women are no less susceptible to kidney and liver disease. In fact, women have higher rates of chronic kidney disease and higher hospitalization rates for end-stage renal disease than men.[8] Why, then, do so many more men receive transplants, and why do so many of men’s transplanted organs come from women?

Biological differences would be an easy explanation. If women were biologically better suited to donate, then surely the high percentage of female donors would not be evidence of inequality, but simply a natural consequence of finding the best donor match in every case.

However, medical and scientific evidence suggests that women are less likely to be the best donors. The risk of a patient losing a transplanted kidney is 15-22% higher if the donor is female, even if the donor and patient are siblings. In addition, male recipients of female hearts are 13-15% more likely to lose the heart than if the donor is also male.[9],[10]

Part of this is because women, on average, have smaller organs than men, even when weight and height are the same. Their immune systems are also different. Further changes occur when a woman has a child. During childbirth, a woman is exposed to her child’s antigens, which alter her immune system and can prevent her from matching with her own blood relatives.[11]

Although modern medical advancements like precise organ size measurements and tailored immunosuppressants can increase chances of female donor success, such solutions do not address the underlying problem: gender bias. Based on biology alone, men should be donating more than women, but they are not donating even half the time.

Sohini concludes that many families may not be willing to invest in a woman who needs a transplant. Healthcare in India is more readily given to sons than to daughters.[12],[13]

In addition, the temporary loss of wages during the donor’s recovery period is a major barrier to donation. In cultures where men tend to be the primary breadwinners in the household, families may push the donor responsibility onto less economically productive relatives, who are typically female.[14]

A study published in Medical Anthropology examined attitudes toward living organ donation in Egypt and Mexico. The researchers found a general tendency to view mothers as “self-sacrificing” and to view living organ donation as a form of “rebirth.” In many cultures, maternal bodies are considered sources of life, both through birth and through the giving of organs.[15]

Priyanka Bhattacharya, a journalist working with the More to Give organ donation campaign in India, writes: “It’s all a part of the social mindset in India, they say. Women, nurturers, sustainers, givers of life – it almost seems natural that in times of need, a woman will step up to donate a kidney or part of her liver to save a loved one. But how natural is it if a widowed sister-in-law is the only ‘available’ donor in a joint family despite there being other siblings more eligible to donate? How natural is it when a young woman is married to someone who already knows he needs an organ transplant at the time of his wedding?”[16]

Living organ donation is undeniably linked to powerful gender ideologies.[17] Discussions surrounding female living organ donation nearly always circle back to gendered division of labor, gender roles in the home and in society, and gender inequality in healthcare.

Some medical professionals, including Sohini’s evaluating doctor, have tried to give women a last-minute way out when the pressure from their families is overwhelming. Sohini’s doctor offered to make up a reason for a clinical rejection if she was feeling scared, coerced, or even ambivalent about the donation. It is harder for families to argue with an official medical rejection.[18],[19]

However, the work of a few good doctors is not enough. A major reassessment of both the organ donation procedure and women’s roles in family and society are necessary in order to fix this imbalance.

Currently, the U.S. healthcare system does little to make living organ donation financially neutral or even feasible for many people. Because men are the primary breadwinners in many modern households, they may be less likely to take the risk. Easing the financial burden for working citizens who become donors could encourage more men to donate.

Furthermore, cadaveric donations are quite rare in India due to cultural misgivings, religious beliefs surrounding death, mistrust in the healthcare system, and reports of organ trafficking.[20] Increasing state capacity to conduct cadaveric organ transplants as well as promoting cultural acceptance of the procedure could increase usage of another viable transplantation option. This would prevent many women from being pressured into unwilling donation by their families.

Above all, in every part of the world, there needs to be a better understanding and acceptance that women’s bodies are not commodities. They are not to be exploited, used, or manipulated for the benefit of others. A woman’s body is her own. The discussion surrounding women’s bodily autonomy in relation to sex and childbirth is gaining traction; let us also consider the implications for transplantation. A woman may be a source of life, but she gets to decide when she bestows it – both through birth and through the willing donation of vital organs.

– by ARR

Photo credit: istockphoto.com

 

Sources

[1] Chattopadhyay, Sohini. 2018. “My father needed a liver. Did it have to be from me?” The New York Times: Opinion. https://www.nytimes.com/2018/12/15/opinion/sunday/india-organ-donation-women.html (January 2019).

[2] Crowley-Matoka, M., and Hamdy, S.F. 2015. “Gendering the Gift of Life: Family Politics and Kidney Donation in Egypt and Mexico.” Medical Anthropology: Cross-Cultural Studies in Health and Illness.

[3] Leander, S.A. 2011. “Gender disparity in living kidney donation.” Nephrology Nursing Journal, 38(1), 87-88.

[4] Gill, J., Joffres, Y., Rose, C., Lesage, J., Landsberg, D., Kadatz, M., and Gill, J. 2018. “The change in living kidney donation in women and men in the United States (2005-2015): A population-based analysis.” Journal of the American Society of Nephrology 29(4), 1301-1308.

[5] Bhattacharya, Priyanka. 2017. “Women donate, men receive: The lopsided truth about organ donations.” NDTV. https://sites.ndtv.com/moretogive/women-donate-men-receive-lopsided-truth-organ-donations-991/ (January 2019).

[6] Chattopadhyay 2018.

[7] Bhattacharya 2017.

[8] Adams, S., Rivara, M., Streja, E., Cheung, A., Arah, O., Kalantar-Zadeh, K., and Mehrotra, R. 2017. “Sex differences in hospitalizations with maintenance hemodialysis.” Journal of the American Society of Nephrology 28(9), 2721-2728.

[9] Zeier, M., Dohler, B., Opelz, G., and Ritz, E. 2002. “The effect of donor gender on graft survival.” Journal of the American Society of Nephrology 13(10), 2570-2576.

[10] Kendrick, M. 2018. “Why do more women donate organs than men?” BBC Future: The Health Gap. http://www.bbc.com/future/story/20180730-why-more-women-donate-organs-than-men (January 2019).

[11] Ibid.

[12] Chattopadhyay 2018.

[13] DACH-PRACTICE-1

[14] Bhattacharya 2017.

[15] Crowley-Matoka, M., and Hamdy, S.F. 2015. “Gendering the Gift of Life: Family Politics and Kidney Donation in Egypt and Mexico.” Medical Anthropology: Cross-Cultural Studies in Health and Illness.

[16] Bhattacharya 2017.

[17] Crowley-Matoka & Hamdy 2015.

[18] Chattopadhyay 2018.

[19] Bhattacharya 2017.

[20] Chattopadhyay 2018.

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2 thoughts on “Rebirth and Transplantation: Women as Givers of Life

  1. V Hudson says:

    This is such an awesome blogpost! I hope it gets wide traction–and the pressure for women to “self-sacrifice” also applies to surrogacy and also to euthanasia. I think it is of a piece.

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