The study shows persistent inequalities in children's access to kidney transplants across the UK

The study shows persistent inequalities in children's access to kidney transplants across the UK

New research presented at Esot Congress 2025 shows persistent inequalities in children's access to life-saving kidney transplants across the UK. The study shows how ethnicity, socioeconomic status and gender significantly influence a child's likelihood of receiving a transplant.

Researchers at the University of Bristol analyzed national data from the UK Kidney Registry and NHS Blood & Transplantation, focusing on patients under 18 who started kidney replacement therapy between 1996 and 2020. Their results show that inequalities in access to transplant waiting lists and to living donor transplants and living donor transplants are increasing.

At the start of their treatment, children from Black and Asian communities, girls, and those living in extremely low-income areas are often less likely to be placed on the transplant waiting list or receive a transplant. Compared to children from wealthier families, children from the lowest income families have a lower 33% chance of being placed on the waiting list. Similarly, girls have a 12% lower chance of being added to the waiting list than boys.

We were particularly impressed by how early these differences appeared in the transplant process. It's not just about who gets a transplant, but who is even considered. “

Dr. Alice James, lead author of the study

Once children are on the waiting list, disparities related to gender and income tend to be reduced, but disadvantages for children from black backgrounds remain. “Those from black ethnic backgrounds face systemic disadvantages, including fewer living donor options, even after being placed on the waiting list,” Dr. James. “This suggests that justice is not achieved through waiting lists.”

These differences can have profound consequences. Delays or lack of access to transplantation, particularly preventive transplantation, prolong children's reliance on dialysis, which is associated with increased morbidity, poorer growth outcomes, cognitive delays, and reduced quality of life.

International comparisons show that these issues are not unique to the UK. Similar disparities in access to pediatric kidney transplantation have been documented in the United States, Canada, and Australia, particularly among Indigenous and ethnic minority populations.

To address these entrenched disparities in pediatric kidney transplant, the research team calls for urgent, system-wide interventions, including earlier referrals, culturally tailored education, and stronger family support. Training clinicians to recognize and address unconscious bias is also critical.

Ongoing research examines how clinicians make decisions and gain deeper insight into families' experiences to identify and address the root causes of inequality. “Our goal now is to simply identify these inequalities in order to do something about them,” emphasized Dr. James. “This includes clinician training, outreach and reforms that focus fairness at every step of the transplant journey.”

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