Barriers to Accessing Kidney Transplantation Among Populations Marginalized by Race and Ethnicity in Canada: A Scoping Review Part 1—Indigenous Communities in Canada

Abstract

Background: Kidney transplantation (KT), a treatment option for end-stage kidney disease (ESKD), is associated with longer survival and improved quality of life compared with dialysis. Inequities in access to KT, and specifically, living donor kidney transplantation (LDKT), have been documented in Canada along various demographic dimensions. In this article, we review existing evidence about inequitable access and barriers to KT and LDKT for patients from Indigenous communities in Canada. Objective: To characterize the current state of literature on access to KT and LDKT among Indigenous communities in Canada and to answer the research question, “what factors may influence inequitable access to KT among Indigenous communities in Canada.” Eligibility criteria: Databases and gray literature were searched in June and November 2020 for full-text original research articles or gray literature resources addressing KT access or barriers in Indigenous communities in Canada. A total of 26 articles were analyzed thematically. Sources of evidence: Gray literature and CINAHL, OVID Medline, OVID Embase, and Cochrane databases. Charting methods: Literature characteristics were recorded and findings which described rates of and factors that influence access to KT were summarized in a narrative account. Key themes were subsequently identified and synthesized thematically in the review. Results: Indigenous communities in Canada experience various barriers in accessing culturally safe medical information and care, resulting in inequitable access to KT. Barriers include insufficient incorporation of Indigenous ways of knowing and being in information dissemination and care for ESKD and KT, spiritual concerns, health beliefs, logistical hurdles to accessing care, and systemic mistrust resulting from colonialism and systemic racism. Limitations: This review included studies that used various methodologies and did not assess study quality. Data on Indigenous status were not reported or defined in a standardized manner. Indigenous communities are not homogeneous and views on organ donation and KT vary by individual. Conclusions: Our scoping review has identified potential barriers that Indigenous communities may face in accessing KT and LDKT. Further research is urgently needed to better understand barriers and support needs and to develop strategies to improve equitable access to KT and LDKT for Indigenous populations in Canada.

Kidney transplant candidates’ and recipients’ perspectives on the decision‐making process to accept or refuse a deceased donor kidney offer: Trust and graft survival matter

“…They are therefore not representative of all KTRs and TCs in Quebec, particularly patients from ethnic groups or living in rural or remote area. Moreover, our study did not address the needs of vulnerable populations who have traditional medical mistrust such as Indigenous populations in Canada 38 or Afro-American population in the United States. 39 Another limitation of our study is that the two investigators facilitating the focus groups are transplant nephrologists who are members of the local transplant medical team.…”

Barriers to Accessing Kidney Transplantation Among Populations Marginalized by Race and Ethnicity in Canada: A Scoping Review Part 2—East Asian, South Asian, and African, Caribbean, and Black Canadians

“…The benefits of kidney transplantation (KT) 1-7 and living donor kidney transplantation (LDKT) 1 for patients with end-stage kidney disease (ESKD) have been documented in the literature, as summarized in part 1 of this review. 8 However, groups marginalized by race and ethnicity face substantial inequities in accessing KT and LDKT. 9,10…”

“…12 The unique histories of each community have shaped complex identities which are dependent on a multitude of factors. Part 1 8 of this review focused on Indigenous, whereas this Part focuses on East Asian, South Asian, and ACB Canadian communities. We chose to use these categories due to the sizes of their respective populations and the common use of these categorizations in research.…”

“…We use the terminology “populations marginalized by race and ethnicity” to refer to multiple communities; rationale for the use of this terminology has been described in Part 1. 8…”

“…The aim of this scoping review is to characterize the currently published data on rates of KT and LDKT among East Asian, South Asian, and ACB Canadian communities and to answer the research question, “what factors may influence inequitable access to KT among East Asian, South Asian, and ACB Canadian communities?” While the review explores the broader topic of KT, there is a focus on LDKT due to the large disparity in access to LDKT among populations marginalized by race and ethnicity in Canada. A scoping review summarizing data on Indigenous communities in Canada is presented in a separate manuscript 8 to allow for thorough exploration of existing evidence while considering publication word limits. A scoping review was conducted to identify and map out the available evidence and knowledge gaps on rates of and barriers to KT and LDKT among populations marginalized by race and ethnicity in Canada.…”