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Letters to the Editor

Re: Distinguishing Between Sex and Gender Is Critical for Research in Transplantation

McElroy, Lisa MD, MS1; Likhitsup, Alisa MD2; Sabeed, Nana MD3; Hassan, Ammar MD4; Winder, G. Scott MD5; Sonnenday, Christopher J. MD, MHS1; Fontana, Robert J. MD4; Mellinger, Jessica L. MD4

Author Information
doi: 10.1097/TP.0000000000002946
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We appreciate the letter by Drs Congly and Brownfield, and we agree on the importance of differentiating between sex and gender since these 2 terms are frequently conflated.1 Much of the literature in transplantation has, as the letter authors point out, focused on sex differences while using the term gender and vice versa. For example, sex differences in MELD scores, particularly GFR, and body size are well known to reduce access to donor organs.2 We also acknowledge the concurrent influence of biologic and sociological factors on drinking behaviors and alcohol-related consequences.3

Our data were extracted manually from the medical record, and although the field in our electronic medical record is labeled sex, it is modified to correspond with gender for our transgendered patients, independent of sexual reassignment status. We considered using the term sex in our title, but our analysis was not designed to determine sex-specific biologic responses to disease or treatments and was instead focused more on the role of culture, socially constructed roles, and identity. Gendered aspects of culture may in fact play a role in decisions to list or not list, as evidenced by the greater percentage of women who were not listed because of active substance use and lower rates of substance use treatment. Although our study was not designed to determine causation, further research should be done to determine to what extent these differences can be attributed to specific gendered cultural roles and expectations (for example, women as caregivers may have less time for attending substance use treatment or women who drink heavily may be perceived differently than male counterparts). Determining which aspects of this disparity are related to sex versus gender is intriguing and should be a subject of further research.


1. Congly SE, Brownfield KA. Distinguishing between sex and gender is critical for research in transplantation.Transplantation2019 Sep 3doi: 10.1097/TP.0000000000002945. [Epub ahead of print]
2. Nephew LD, Goldberg DS, Lewis JD, et al. Exception points and body size contribute to gender disparity in liver transplantation.Clin Gastroenterol Hepatol2017151286–1293.e2
3. Erol A, Karpyak VM. Sex and gender-related differences in alcohol use and its consequences: contemporary knowledge and future research considerations.Drug Alcohol Depend20151561–13
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