Introduction: Globally, more women than men live with chronic kidney disease, though women are less likely to receive a kidney transplant. We aimed to describe the perspectives and experiences of women with a kidney transplant on access to transplantation and associated healthcare.
Methods: We conducted semi-structured interviews with women with a kidney transplant over the age of 18 years from 16 countries from August 2022 to January 2024. Transcripts were analysed thematically.
Results: Thirty-nine women were interviewed, ranging from 27 to 72 years.  Participants were from high (n=21), upper middle (n=6) and lower middle (n=12) income countries and 17 spoke English as a first language. We identified six themes: social vulnerability in preventing access (with subthemes of spousal/family dominance in decision making, financial dependence on others, reversal of role as caregiver), disempowerment and loss of control (forced to relinquish decisions about their body, exhausted from self-advocating) and systems unresponsive to individual needs (overwhelmed by information, unreliable supply of medications, navigating silos within healthcare systems, inability to access genetic counselling), struggling to achieve parenthood (grieving lost opportunity for pregnancy, medicalization of the journey to motherhood, exploring other options to have a child, difficulty parenting with chronic illness), broaching gender sensitive and taboo topics (loss of sexuality and libido, stigma of mental health impacts, managing menopause, impaired body image, embarrassment about incontinence) and yearning for peer connection and mutual empowerment (forming platforms for sharing experiences, education and support).
Conclusion: Women with a kidney transplant face social, financial and cultural barriers to accessing transplantation. More specific challenges related to post transplant care included reduced access to support for psychosocial wellbeing and body image, women’s health and family planning which is of priority for recipients. Improved availability of educational resources targeted at women about transplantation, which includes family planning and women’s health will create awareness and empower women to strive for equitable access to care and health outcomes worldwide.