Native people face many barriers to medical care. Some are widely recognized, such as a lack of individual health insurance, or an absence of accessible, high-quality healthcare services. But other barriers are less obvious, as researchers with Partnerships for Native Health recently discovered.
For a study entitled “Culturally Adapted Strategies to Enhance Kidney Donation in Native Communities,” community health educators have been visiting Native patients on kidney dialysis to provide education and facilitation around the process of kidney transplantation. This study involves patients in urban and rural areas of two western states. Notably, Native people have high rates of chronic kidney disease and kidney dialysis, but low rates of kidney transplants. As our community educators have learned, several unforeseen barriers contribute to these low rates. All involve health system factors, and all might seem relatively simple or mundane – unless you happen to be a Native patient waiting for a new kidney.
First, anyone who seeks an organ transplant must adhere to a specific medical protocol. Among other criteria, the patient must have a healthy weight, no periodontal disease, no advanced cardiovascular disease, and no substance use issues. We found that many Native patients have trouble fulfilling this protocol. Often the reason is a common condition: being overweight, having active gum disease, or smoking cigarettes. Unfortunately, many urban and rural Natives lack access to the specialty services needed to address these problems. As an example, dentistry is not covered by Medicare, and periodontal care is not always provided by tribal health systems. Yet any of these conditions can disqualify a person from receiving or donating an organ.
Second, any patient wishing to receive a kidney transplant must pass a financial evaluation. Patients must demonstrate their ability to pay for a portion of the costs of transplant surgery (since Medicare covers only 80%). They must also be able to pay for post-transplant costs, including expensive anti-rejection medications. People who live in poverty and reside in states that did not opt for Medicaid expansion might find it impossible to pass the financial evaluation. This barrier is especially significant for Native Americans, who experience the highest rates of poverty of any race in the U.S.
Third, if you qualify for a kidney, but you need to travel to a distant transplant center for the procedure, you must be accompanied by a friend or family member. That person must commit to staying with you day and night during the recovery process, which lasts for approximately 30 to 60 days after surgery. Despite the strong family structures typical of Native cultures, many patients have difficulty finding someone who can make that commitment.
Active research on health disparities is only one component in the process of remedying health disparities. Partnerships for Native Health advocates for policy changes to enable more Native Americans to receive organ transplants that will save their lives. Identifying barriers is the first step in the process of positive change. We’re already involved in efforts to take the next steps.