{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T16:32:19Z","timestamp":1778171539375,"version":"3.51.4"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T00:00:00Z","timestamp":1706227200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl Int"],"abstract":"<jats:p>Patients from minoritized backgrounds based on race\/ethnicity, gender, sexuality, and other social identities are more likely to experience inequities in access in kidney transplantation. Although these inequities have been reported over the decades, limited research focuses on the experiences of patients with intersecting minoritized social statuses and the mechanisms that contribute to their reduced access to transplantation. Intersectionality, a framework for understanding the ways in which multiple social identities represent interacting systems of oppression and privilege, offers a nuanced approach for understanding the experiences of patients diagnosed with end-stage organ disease with intersecting social identities. This article outlines complex systems that perpetuate inequities by highlighting the value of intersectionality in studying disparate outcomes to transplant and providing recommendations for the transplant community. This article aligns with the ESOT call for action to promote equity in transplantation worldwide.<\/jats:p>","DOI":"10.3389\/ti.2024.11658","type":"journal-article","created":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T04:11:34Z","timestamp":1706242294000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Systems Connected to Inequities in Access to Kidney Transplantation and the Value of Intersectionality"],"prefix":"10.3389","volume":"37","author":[{"given":"Camilla W.","family":"Nonterah","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of Chronic Kidney Disease: An Update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int Suppl"},{"key":"B2","volume-title":"USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States","year":"2022"},{"key":"B3","volume-title":"The Health Economics of Kidney Disease to 2033","year":"2023"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2325","DOI":"10.1097\/TP.0000000000003585","article-title":"Disparities in Access to Kidney Transplantation in Developing Countries","volume":"105","author":"Elrggal","year":"2021","journal-title":"Transplantation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"100654","DOI":"10.1016\/j.trre.2021.100654","article-title":"Non-Medical Barriers in Access to Early Steps of Kidney Transplantation in the United States \u2013 A Scoping Review","volume":"35","author":"Harding","year":"2021","journal-title":"Transplant Rev (Orlando)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1097\/TP.0b013e3181e346e3","article-title":"Social Deprivation, Ethnicity, and Access to the Deceased Donor Kidney Transplant Waiting List in England and Wales","volume":"90","author":"Udayaraj","year":"2010","journal-title":"Transplantation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"11216","DOI":"10.3389\/ti.2023.11216","article-title":"Inequities in Organ Donation and Transplantation Among Immigrant Populations in Italy: A Narrative Review of Evidence, Gaps in Research and Potential Areas for Intervention","volume":"36","author":"Grossi","year":"2023","journal-title":"Transpl Int"},{"key":"B8","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s12882-018-0901-x","article-title":"Effectiveness of Informational Decision Aids and a Live Donor Financial Assistance Program on Pursuit of Live Kidney Transplants in African American Hemodialysis Patients","volume":"19","author":"Boulware","year":"2018","journal-title":"BMC Nephrol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1097\/TP.0000000000002655","article-title":"Equally Interchangeable? How Sex and Gender Affect Transplantation","volume":"103","author":"Melk","year":"2019","journal-title":"Transplantation"},{"key":"B10","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1016\/j.pec.2019.11.005","article-title":"Pre-Transplant Evaluation Completion for Black\/African American Renal Patients: Two Theoretical Frameworks","volume":"103","author":"Nonterah","year":"2020","journal-title":"Patient Educ Couns"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2899","DOI":"10.1111\/ajt.15963","article-title":"Kidney Transplantation and Donation in the Transgender Population: A Single-Institution Case Series","volume":"20","author":"Ramadan","year":"2020","journal-title":"Am J Transpl"},{"key":"B12","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1097\/MOT.0000000000000909","article-title":"Gender Disparities in Transplantation","volume":"26","author":"Sheikh","year":"2021","journal-title":"Curr Opin Organ Transpl"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.2215\/CJN.11731111","article-title":"Impact of Navigators on Completion of Steps in the Kidney Transplant Process: A Randomized, Controlled Trial","volume":"7","author":"Sullivan","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1177\/15269248231164164","article-title":"A Nominal Group Technique Study of Patients Who Identify as Black or African American and Access to Renal Transplantation","volume":"33","author":"Nonterah","year":"2023","journal-title":"Prog Transpl"},{"key":"B15","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An Ecological Perspective on Health Promotion Programs","volume":"15","author":"McLeroy","year":"1988","journal-title":"Health Educ Q"},{"key":"B16","doi-asserted-by":"publisher","first-page":"282","DOI":"10.4278\/0890-1171-10.4.282","article-title":"Translating Social Ecological Theory Into Guidelines for Community Health Promotion","volume":"10","author":"Stokols","year":"1996","journal-title":"Am J Health Promot"},{"key":"B17","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.semnephrol.2009.10.010","article-title":"Addressing Racial and Ethnic Disparities in Live Donor Kidney Transplantation: Priorities for Research and Intervention","volume":"30","author":"Waterman","year":"2010","journal-title":"Semin Nephrol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1111\/ajt.16543","article-title":"Dismantling Structural Racism as a Root Cause of Racial Disparities in COVID-19 and Transplantation","volume":"21","author":"Purnell","year":"2021","journal-title":"Am J Transpl"},{"key":"B19","doi-asserted-by":"publisher","first-page":"10787","DOI":"10.3389\/ti.2022.10787","article-title":"Eliminating Race From eGFR Calculations: Impact on Living Donor Programs","volume":"35","author":"Bellini","year":"2022","journal-title":"Transpl Int"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2289","DOI":"10.1001\/jama.2022.7310","article-title":"Race-Free Estimation of Kidney Function: Clearing the Path Toward Kidney Health Equity","volume":"327","author":"Boulware","year":"2022","journal-title":"JAMA"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e0276252","DOI":"10.1371\/journal.pone.0276252","article-title":"Systematic Review of International Studies Evaluating MDRD and CKD-EPI Estimated Glomerular Filtration Rate (eGFR) Equations in Black Adults","volume":"17","author":"Umeukeje","year":"2022","journal-title":"PLoS One"},{"key":"B22","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s12939-021-01616-x","article-title":"A Scoping Review of Inequities in Access to Organ Transplant in the United States","volume":"21","author":"Park","year":"2022","journal-title":"Int J Equity Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"100614","DOI":"10.1016\/j.trre.2021.100614","article-title":"Gender and Race\/Ethnicity Differences in Living Kidney Donor Demographics: Preference or Disparity?","volume":"35","author":"Ross","year":"2021","journal-title":"Transplant Rev (Orlando)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s12882-021-02262-9","article-title":"An Intersectional Gender Analysis in Kidney Transplantation: Women Who Donate a Kidney","volume":"22","author":"Rota-Musoll","year":"2021","journal-title":"BMC Nephrol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"11206","DOI":"10.3389\/ti.2023.11206","article-title":"Representation of Women in Contemporary Kidney Transplant Trials","volume":"36","author":"Vinson","year":"2023","journal-title":"Transpl Int"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e540","DOI":"10.1097\/TXD.0000000000000986","article-title":"Mediators of Socioeconomic Inequity in Living-Donor Kidney Transplantation: Results From a UK Multicenter Case-Control Study","volume":"6","author":"Bailey","year":"2020","journal-title":"Transplant Direct"},{"key":"B27","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1037\/\/0003-066x.54.10.805","article-title":"Racism as a Stressor for African Americans. A Biopsychosocial Model","volume":"54","author":"Clark","year":"1999","journal-title":"Am Psychol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1037\/h0087722","article-title":"A Multidimensional Conceptualization of Racism-Related Stress: Implications for the Well-Being of People of Color","volume":"70","author":"Harrell","year":"2000","journal-title":"Am J Orthopsychiatry"},{"key":"B29","doi-asserted-by":"publisher","first-page":"105339","DOI":"10.1016\/j.psyneuen.2021.105339","article-title":"A Randomized Trial of Race-Related Stress Among African Americans With Chronic Kidney Disease","volume":"131","author":"Arriola","year":"2021","journal-title":"Psychoneuroendocrinology"},{"key":"B30","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1093\/gerona\/glz294","article-title":"Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study","volume":"75","author":"Cobb","year":"2020","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"B31","volume-title":"Minority Stress and Lesbian Women","author":"Brooks","year":"1981"},{"key":"B32","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1037\/0033-2909.129.5.674","article-title":"Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence","volume":"129","author":"Meyer","year":"2003","journal-title":"Psychol Bull"},{"key":"B33","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1093\/ajhp\/zxz023","article-title":"Transgender\/Gender Nonconforming Adults\u2019 Worries and Coping Actions Related to Discrimination: Relevance to Pharmacist Care","volume":"76","author":"Lewis","year":"2019","journal-title":"Am J Health Syst Pharm"},{"key":"B34","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12939-022-01795-1","article-title":"Intersectionality, Health Equity, and EDI: What's the Difference for Health Researchers?","volume":"21","author":"Kelly","year":"2022","journal-title":"Int J Equity Health"},{"key":"B35","volume-title":"2020 Census Illuminates Racial and Ethnic Composition of the Country","author":"Jones","year":"2021"},{"key":"B36","volume-title":"Ethnic Group, England and Wales: Census 2021","year":"2022"},{"key":"B37","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1080\/10478401003676501","article-title":"Diversity Science: Why and How Difference Makes a Difference","volume":"21","author":"Plaut","year":"2010","journal-title":"Psychol Inq"},{"key":"B38","article-title":"Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics","volume":"1","author":"Crenshaw","year":"1989","journal-title":"Univ Chicago Leg Forum"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.2105\/AJPH.2012.300750","article-title":"The Problem With the Phrase Women and Minorities: Intersectionality-An Important Theoretical Framework for Public Health","volume":"102","author":"Bowleg","year":"2012","journal-title":"Am J Public Health"},{"key":"B40","doi-asserted-by":"publisher","first-page":"917","DOI":"10.2105\/AJPH.2020.305766","article-title":"We're Not All in This Together: On COVID-19, Intersectionality, and Structural Inequality","volume":"110","author":"Bowleg","year":"2020","journal-title":"Am J Public Health"},{"key":"B41","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1093\/heapro\/daz080","article-title":"Applying Intersectionality Theory in Health Promotion Research and Practice","volume":"35","author":"Heard","year":"2020","journal-title":"Health Promot Int"},{"key":"B42","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1038\/s41581-023-00715-y","article-title":"Intersectionality as a Lens for Achieving Kidney Health Justice","volume":"19","author":"Lett","year":"2023","journal-title":"Nat Rev Nephrol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.2215\/CJN.01950219","article-title":"Advancing Equity in Nephrology: Enhancing Care for LGBTQ+ Patients and Our Workforce","volume":"14","author":"Mohottige","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1764","DOI":"10.2215\/CJN.12531213","article-title":"Sex Differences and Attitudes Toward Living Donor Kidney Transplantation Among Urban Black Patients on Hemodialysis","volume":"9","author":"Gillespie","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1097\/TP.0000000000000271","article-title":"Disparities in Completion Rates of the Medical Prerenal Transplant Evaluation by Race or Ethnicity and Gender","volume":"99","author":"Monson","year":"2015","journal-title":"Transplantation"},{"key":"B46","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1037\/cou0000062","article-title":"Construction and Initial Validation of the Gendered Racial Microaggressions Scale for Black Women","volume":"62","author":"Lewis","year":"2015","journal-title":"J Couns Psychol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1037\/a0023244","article-title":"Measuring Multiple Minority Stress: The LGBT People of Color Microaggressions Scale","volume":"17","author":"Balsam","year":"2011","journal-title":"Cultur Divers Ethnic Minor Psychol"},{"key":"B48","first-page":"1532","article-title":"Effects of Perceived Racism, Cultural Mistrust and Trust in Providers on Satisfaction With Care","volume":"98","author":"Benkert","year":"2006","journal-title":"J Natl Med Assoc"},{"key":"B49","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1097\/PSY.0000000000000684","article-title":"Expectations of Racism and Carotid Intima-Media Thickness in African American Women","volume":"81","author":"Lewis","year":"2019","journal-title":"Psychosom Med"},{"key":"B50","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1037\/\/0022-3514.83.4.896","article-title":"Sensitivity to Status-Based Rejection: Implications for African American Students' College Experience","volume":"83","author":"Mendoza-Denton","year":"2002","journal-title":"J Pers Soc Psychol"},{"key":"B51","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1177\/135910539700200305","article-title":"Racial Differences in Physical and Mental Health: Socioeconomic Status, Stress, and Discrimination","volume":"2","author":"Williams","year":"1997","journal-title":"J Health Psychol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1177\/0146167295218007","article-title":"Neosexism: Plus \u00c7a Change, Plus C'est Pareil","volume":"21","author":"Tougas","year":"1995","journal-title":"Pers Soc Psychol Bull"},{"key":"B53","doi-asserted-by":"publisher","first-page":"387","DOI":"10.3389\/fpsyg.2018.00387","article-title":"Attitudes Toward Transgender Men and Women: Development and Validation of a New Measure","volume":"9","author":"Billard","year":"2018","journal-title":"Front Psychol"},{"key":"B54","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1037\/hea0001275","article-title":"Structural Equation Model of Intersectional Microaggressions, Discrimination, Resilience, and Mental Health Among Black Women With HIV","volume":"42","author":"Dale","year":"2023","journal-title":"Health Psychol"},{"key":"B55","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1111\/ajt.15526","article-title":"Association of Sociocultural Factors With Initiation of the Kidney Transplant Evaluation Process","volume":"20","author":"Hamoda","year":"2020","journal-title":"Am J Transpl"},{"key":"B56","doi-asserted-by":"publisher","first-page":"10084","DOI":"10.3389\/ti.2022.10084","article-title":"Inequitable Access to Transplants: Adults With Impaired Decision-Making Capacity","volume":"106","author":"Thom","year":"2022","journal-title":"Transplantation"},{"key":"B57","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1177\/0361684316654282","article-title":"Invited Reflection: Quantifying Intersectionality","volume":"40","author":"Bowleg","year":"2016","journal-title":"Psychol Women Q"},{"key":"B58","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1177\/0361684316629797","article-title":"Intersectionality in Quantitative Psychological Research: I. Theoretical and Epistemological Issues","volume":"40","author":"Else-Quest","year":"2016","journal-title":"Psychol Women Q"},{"key":"B59","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1186\/s12939-021-01509-z","article-title":"\u2018Doing\u2019 or \u2018Using\u2019 Intersectionality? Opportunities and Challenges in Incorporating Intersectionality Into Knowledge Translation Theory and Practice","volume":"20","author":"Kelly","year":"2021","journal-title":"Int J Equity Health"},{"key":"B60","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1037\/cdp0000477","article-title":"Toward a Socially Just Diversity Science: Using Intersectional Mixed Methods Research to Center Multiply Marginalized Black, Indigenous, and People of Color (BIPOC)","volume":"29","author":"Watson-Singleton","year":"2023","journal-title":"Cultur Divers Ethnic Minor Psychol"},{"key":"B61","doi-asserted-by":"publisher","first-page":"772301","DOI":"10.3389\/fpubh.2021.772301","article-title":"The Intersectionality Toolbox: A Resource for Teaching and Applying an Intersectional Lens in Public Health","volume":"9","author":"Sabik","year":"2021","journal-title":"Front Public Health"},{"key":"B62","volume-title":"What People Misunderstand About Anti-Racism Training","author":"Asare","year":"2022"},{"key":"B63","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-76849-2","volume-title":"A Cultural Safety Approach to Health Psychology","author":"Thompson","year":"2021"},{"key":"B64","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1353\/hpu.2010.0233","article-title":"Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education","volume":"9","author":"Tervalon","year":"1998","journal-title":"J Health Care Poor Underserved"},{"key":"B65","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1681\/ASN.2022040429","article-title":"The Case for Prioritizing Diversity in the Transplantation Workforce to Advance Kidney Health Equity","volume":"33","author":"Butler","year":"2022","journal-title":"J Am Soc Nephrol"},{"key":"B66","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.jnma.2019.01.006","article-title":"Diversity Improves Performance and Outcomes","volume":"111","author":"Gomez","year":"2019","journal-title":"J Natl Med Assoc"},{"key":"B67","article-title":"Making Space When Black Voices Speak Their Truth","volume-title":"Anti-Blackness, White Privilege and Authentic Allyship","author":"Nonterah","year":"2024"}],"container-title":["Transplant International"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2024.11658\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T04:11:39Z","timestamp":1706242299000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2024.11658\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,26]]},"references-count":67,"alternative-id":["10.3389\/ti.2024.11658"],"URL":"https:\/\/doi.org\/10.3389\/ti.2024.11658","relation":{},"ISSN":["1432-2277"],"issn-type":[{"value":"1432-2277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,26]]},"article-number":"11658"}}