Experiential Evidence of Systemic Racism for Indigenous Peoples Navigating Transplantation in Canada

Abstract

Introduction: Despite previous data stating that Indigenous patients with kidney failure are 66% less likely to receive a kidney transplant compared with White Canadians, there is a very limited understanding of the barriers and challenges experienced and described by Indigenous Peoples when accessing kidney transplantation. The aim of this study was to describe the perspectives and experiences of Indigenous kidney transplant candidates and recipients, living kidney donors, and Elders on access to kidney transplantation in British Columbia, Canada in the hopes of codeveloping and implementing health services interventions to address systemic barriers to transplantation.

Methods: Semistructured interviews were conducted with 19 participants and 4 focus groups were conducted with 18 participants (n = 37). Transcripts were thematically analyzed.

Results: Five themes were identified as follows: (i) confronting uncertainty and risk, (ii) culture of giving, (iii) systemic racism and discrimination, (iv) navigating complexities of transplant and donation process, and (v) a lack of culturally safe care.

Conclusion: These findings highlight that Indigenous patients face potentially modifiable barriers that may be amenable to health system improvements, such as development of culturally safe patient education tools and Indigenous-specific navigation supports. Health services and policy interventions need to be explored and evaluated to begin to address inequities in access to transplantation.

Keywords: access to transplantation; health equity; indigenous cultural safety; indigenous health; kidney transplantation; living kidney donation.

Graphical abstract

Figure 1

Thematic Schema. This figure outlines the key themes and sub-themes identified with arrows illustrating the links between different themes. The shaded grey box represents the only theme that was a facilitator, “Culture of giving.”