Kidney Transplant Access for Indigenous in Interior Health

Research highlights significant disparities faced by Indigenous populations in kidney transplantation. Indigenous individuals experience higher rates of chronic kidney disease and end-stage renal disease, with contributing factors such as diabetes, obesity, and socio-economic challenges (Ferguson et al., 2024). However, Indigenous are less likely to receive kidney transplants and often experience worse post-transplant outcomes compared to non-Indigenous patients (McGuire et al., 2020). These disparities are exacerbated by bias in healthcare settings, including poor communication, lack of cultural competence, and systemic barriers to organ transplantation (Walker et al., 2019). Additionally, limited access to healthcare in rural and remote communities further disadvantages Indigenous patients (Tait, 2022). This is particularly problematic as the pre-kidney transplant process is lengthy and requires access to a wide range of resources and diagnostic services. The situation is even more heartbreaking given the strong desire of many Indigenous people to receive transplants rather than continue bearing the burdens of dialysis care (Tait, 2022).  

Within my kidney care team at Interior Health, I have heard similar concerns, particularly regarding the longer wait times for transplant patients in Interior Health compared to those in the Lower Mainland. Several quality improvement initiatives have been implemented to address these issues. Last year, our program utilized digital solutions, PROMIS and CareConnect, to enhance transplant statistics and monitoring. Our team now enters kidney transplant statistics and screening data into PROMIS as it aids in data analyzing and notifying kidney transplant teams in BC Renal. Additionally, we implemented a Nephrology Clinic Note in CareConnect (the provincial Electronic Medical Record), which can be accessed across health regions in British Columbia. This means that transplant-related notes for Interior Health patients are visible at the transplant hospitals in Vancouver, improving communication and speeding up notification for candidates in Interior Health.  

Further, kidney transplant education is not currently standardized regionally, but Interior Health is working to change this with input from patient partners and regional team leads, including a focus on Indigenous patient needs. A BC Renal funded project is finalizing a kidney transplant educational webpage for the BRIDGE program, which will be available to all BC health authorities (BC Renal, n.d.; Gill, 2024). Interior Health leads participate in BC Renal committees, ensuring alignment with the provincial initiative. Their involvement helps shape the upcoming standardized education and ensures regional resources follow BRIDGE principles.

In conclusion, addressing the disparities in kidney transplantation for Indigenous populations requires a multifaceted approach. In the Renal Program at Interior Health, we are actively working to reduce these gaps by utilizing digital solutions and creating culturally safe kidney transplant education for patients.