Study reveals persistent inequalities in children's access to kidney transplants across the UK

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

Researchers from the University of Bristol analysed national data from the UK Renal Registry and NHS Blood & Transplant, focusing on patients under 18 years who started kidney replacement therapy between 1996 and 2020. Their findings reveal concerning disparities in access to transplant waitlists and to both deceased and living donor kidney transplants.

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

We were particularly struck by how early these disparities appear in the transplant process. It's not just about who gets a transplant, but who even gets considered in the first place."

Dr. Alice James, lead author of the study

Once children are waitlisted, disparities related to gender and income tend to reduce, but disadvantages for children from Black backgrounds persist. "Those from Black ethnic backgrounds face systemic disadvantages even after being placed on the waitlist, including fewer living donor opportunities," Dr. James explained. "This suggests that equity isn't achieved by waitlisting alone."

These disparities can have profound consequences. Delays or lack of access to transplantation, especially pre-emptive transplants, 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 paediatric kidney transplant access have been documented in the United States, Canada, and Australia, particularly among Indigenous and ethnic minority populations.

To address these entrenched disparities in paediatric kidney transplantation, the research team is calling for urgent, system-wide action, including earlier referrals, culturally tailored education, and stronger family support. Training clinicians to recognise and address unconscious bias is also critical.

Ongoing research is exploring how clinicians make decisions and gaining deeper insight into families' experiences, with the goal of identifying and resolving the root causes of inequity. "Our goal now is to move from simply identifying these inequities to actually doing something about them," Dr. James emphasised. "That includes clinician education, family outreach, and reforms that centre fairness in every step of the transplant pathway."