Patients with kidney failure who lack access to kidney transplantation persist in terms of race, age, sex, and characteristics of other patient. To understand concerns and perceived barriers that dialysis patients have about pursuing transplantation, and what patient characteristics with such concerns are associated. Older age was independently associated with high health-related concerns. Patients having such concerns had less than half the chance of getting listed for a transplant as initiating dialysis was linked with high psychosocial concerns. The older patients, women, and less educated individuals have more concerns about transplantation. Transplantation should inspire the development of programs to address these concerns and help patients make the most informed treatment decisions possible. Living donor kidney transplantation is the treatment of choice for patients with kidney failure, but disparities among certain groups including blacks and women. Such aspects in recent research has focused primarily at the transplant clinic level, but those might be underestimated when only patients undergoing evaluations in transplant. Women were less likely to want to undergo living donor kidney transplantation compared with men despite being nearly twice as likely as men to receive unsolicited offers for kidney transplants from family and friends. Women were also found to be less likely to have been evaluated for a kidney transplant. After controlling for various factors known to influence transplant decisions, women were 87% less likely to want to undergo living donor kidney transplantation than men.

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