Kidney Transplantation in Native Americans: Time to Explore, Expel Disparity

Native Americans/American Indians (NA/AI) are perhaps the most disadvantaged population in the United States due to poverty, geographic isolation, and poor health care. The prevalence of diabetes mellitus and end-stage renal disease in NA/AI is higher compared with other racial/ethnic groups. Thus, a higher rate of kidney transplantation (KT) candidacy evaluation, wait-listing, and actual transplantation would be expected among NA/AI. However, KT is an underutilized life-saving therapy in this population. Half of the 20 poorest counties in the U.S. are within NA/AI reservations. Native Americans/American Indians residing on reservations are often isolated hundreds of miles from the nearest transplant center. Additionally, factors such as poor health literacy, distrust, and substance abuse contribute to low KT rates. However, collaboration between transplant centers and Indian Health Services, use of telemedicine, constructing socioculturally-competent educational strategies, and maintaining confidence-building measures to bridge the gap, create trust, and maintain patient autonomy could improve outcomes in this population.