Transplant Care Strategies to Target Mistrust, Close Gaps in Indigenous Communities

Reducing disparities in transplant access for those who reside in Indigenous communities will involve addressing mistrust of the healthcare system, geographic barriers, and making education and resources accessible and patient-centered.¹

Jagbir Gill, MD, Associate Professor of Medicine in the Division of Nephrology at the University of British Columbia (UBC), shared these common-sense patient-centered solutions to transplant inequities at the 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT), and then sat down with HCPLive for an interview.

The Residential School System and a Foundation of Mistrust

The residential school system Gill refers to was a government-funded, church-run program in Canada, established in the 19th century, where children from Indigenous families were forcibly removed from their homes. The United States, similarly, implemented “boarding schools” where assimilation tactics and abuses took place.^1,2

In his practice, Gill has seen patients who are residential school survivors, along with children and grandchildren of survivors, noting the remaining and significant amount of mistrust in the healthcare system.

“Entering a hospital or clinical environment—which can feel very institutional—can be deeply triggering,” said Gill. “That creates a real challenge when patients are trying to access care that is meant to help or save their lives.”

Approaching Geographic Barriers In Remote/Rural Communities

Often, communities with Indigenous individuals exist in rural or remote areas, outside the breadth of hospitals or healthcare options. Gill’s research revealed that missed appointments were attributed to long-distance transportation hurdles, lost wages, and lack of childcare, not non-adherence.

“As it stands, the model of care for complex services like transplantation is based in large urban hubs and major hospitals. These systems were not designed to meet the needs of patients living in rural and remote regions,” Gill explained. “If we consider the history, the high proportion of Indigenous peoples living in rural and remote areas is not entirely by choice. There has been significant historical displacement, which must also be taken into account.”

One approach to adapting the model of care to these patients' needs is to meet them where they are. This involves bringing resources into communities or making healthcare more accessible through clustered, coordinated transplant workups.

“You have to understand context,” said Gill. “If someone is working as a fisherman and is away for extended periods, that is not non-adherence. If someone misses appointments because they live three and a half hours away or lack phone coverage, that is not non-adherence either.”

Gill gives the example of having a patient come for a week-long stay at a further transplantation center for thorough, pre-planned appointments. By combining these pieces into one trip, this rules out the problem of needing to coordinate multiple trips to transplant centers across multiple dates. Otherwise, virtual care can also be a solution to answering this unmet need.

However, funding remains a key structural part of gaining access to these resources, especially in setting up nurse navigators and coordinating these tests and appointments.

How Storytelling With Community Leaders Can Build Awareness and Trust

When Gill and colleagues were developing their care model, they reached into Indigenous communities for patient-centered recommendations. They found that the existing education materials, which were primarily written, did not “resonate” with patients.

Since oral storytelling is central in Indigenous cultures, Gill and colleagues recognized the broader power of visual storytelling to connect patients with pertinent health information. They developed an education pathway by including prominent Indigenous community members with organ transplantation experience in testimonial videos, to encourage self-advocacy. They even touched on complex topics such as approaching someone about being a living kidney donor.

“Hearing directly from individuals with lived experience—patients who have undergone kidney disease, transplantation, or living donation—is much more powerful than hearing from healthcare workers who are adjacent to that experience,” said Gill.

What Can Clinicians Do Differently to Support These Populations?

Gill underscores the importance of treating patients with empathy and understanding for their cultural history.

Team-based care and representation are hugely important, especially having an Indigenous wellness liaison to support patients and serve as an advocate. During activation rounds, they operate as a perspective to help identify blind spots.

“So we have to make decisions about allocation. The key principle is to start with those who need the most support—not necessarily the largest group or the loudest voice, but those with the greatest need,” said Gill. “That is the approach we’ve taken: provide a high standard of support to the highest-need populations first, and then expand from there to other groups who also require assistance but may not require the same level of intensity.”

Editor’s Note: Gill reports no relevant disclosures.

References

1. Canadian nephrologist shares common-sense, patient-centered solutions to transplant inequities. EurekAlert! Published April 22, 2026. Accessed April 23, 2026. https://www.eurekalert.org/news-releases/1124730

2. Park K. INDIGENOUS BOARDING SCHOOLS IN THE UNITED STATES AND CANADA: POTENTIAL ISSUES AND OPPORTUNITIES FOR REDRESS AS THE UNITED STATES GOVERNMENT INITIATES FORMAL INVESTIGATION. University of Oklahoma College of Law Digital Commons. Published online 2023. Accessed April 23, 2026. https://digitalcommons.law.ou.edu/cgi/viewcontent.cgi?article=1764&context=ailr